UC-NRLF 


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171 


THE    HEALTH    OF   THE   CHILD 


THE    HEALTH    OF 
THE   CHILD 

A  MANUAL  FOR  MOTHERS  AND  NURSES 

BY 

O.     HILDESHEIM 

M.D.,  B.CH.  OXON. 

Late  House  Physician,  Hospital  for  Sick  Children 
Great  Ormond  Street 

WITH   AN   INTRODUCTION   BY 

GEORGE    FREDERIC    STILL 

M.A.,  M.D.  (CANTAB.),  F.R.C.P.  (LONDON) 

Professor  of  Diseases  of  Children,  King's  College,  London 

Physician  to  Out-patients,  Hospital  for  Sick  Children 

Great  Ormond  Street 


NEW    YORK 

FREDERICK  A.   STOKES   COMPANY 
PUBLISHERS 


TO 
JOHN,    ROGER   AND   MICHAEL 


3591 


oo 


4  We  should  be  showing  ourselves  less  generous 
than  the  cave-men,  if,  now  that  our  turn  has  come, 
we  did  not  strive  to  make  life  better  and  more 
secure  for  our  children  than  it  is  for  ourselves. 
To  achieve  this  end,  two  things  are  indispensable, 
knowledge  and  love;  for  with  knowledge  and  love 
the  world  is  made.' — My  Friend's  Book. 

ANATOLE  FRANCE. 


INTRODUCTION 

I  SUPPOSE  there  is  no  great  undertaking 
in  life  that  is  more  commonly  approached 
without  training  or  forethought  than  the  up- 
bringing of  children.  I  am  speaking  of  their 
physical  care,  and  surely  it  is  a  great  under- 
taking. The  future  of  a  nation  lies  with  its 
children,  and  the  future  of  its  children  is 
bound  up  with  their  health. 

It  has  been  the  custom  to  assume  that  any 
woman  can  tend  the  rearing  of  a  child,  an 
assumption  which  implies  either  that  the 
proper  care  of  children  requires  no  special 
knowledge  at  all,  or  that  this  knowledge  is 
somehow  present  in  women  as  a  matter  of 
instinct. 

The  lower  animals,  it  is  true,  are  guided  by 
instinct  in  caring  for  their  young,  but  in  the 
course  of  evolution,  social  and  otherwise, 

vii 


viii     THE  HEALTH  OF  THE  CHILD 

man,  homo  sapiens,  has  travelled  so  far  from 
the  ways  of  nature  that  natural  instinct  is  no 
longer  a  safe  guide.  Evolution  has  produced 
not  only  the  upright  position,  and  the  pre- 
hensile digit,  but  also  the  modern  milkman 
and  the  patent  food,  and  many  another  com- 
plication which  adds  danger  and  perplexity 
to  the  care  of  the  young. 

The  need  for  instruction  grows  more  instead 
of  less  as  civilisation  advances  and  the  com- 
plexity of  modern  life  increases,  for,  not  only 
are  there  introduced  dangers  and  difficulties, 
appertaining  to  artificial  ways  of  life,  but  at 
the  period  when  most  an  infant  should  receive 
from  its  mother  the  nourishment  which  above 
all  others  lays  the  foundation  of  a  sound  and 
healthy  constitution,  this  is  becoming  less  and 
less  often  possible  of  attainment.  The  reasons 
for  this  are  twofold,  the  exigencies  of  modern 
social  life  which  intervene  increasingly  between 
mother  and  child,  and,  a  fact  of  sinister  out- 
look, the  diminishing  capacity  for  suckling 
which  seems  to  be  one  of  the  penalties  of 
present  day  conditions. 


INTRODUCTION  ix 

Nevertheless,  a  wisely  directed  teaching 
may  do  much  to  safeguard  the  period  of 
infancy  and  childhood.  Ignorance  even  more 
than  disability  is  responsible  for  the  heavy 
mortality  in  infancy,  and  for  much  pre- 
ventable disease  in  early  life. 

Already  there  are  signs  that  the  haphazard 
method,  or  rather  lack  of  method,  which  has 
prevailed  in  the  rearing  of  children,  especially 
amongst  the  poor,  is  giving  place  to  something 
better.  Infant  Consultations  and  Schools  for 
Mothers  are  teaching  the  essentials  of  child- 
care,  and  those  of  us  who  have  seen  the  un- 
doubted improvement  resulting  from  the  less 
directly  educational  work  of  the  out-patient 
departments  in  children's  hospitals  will  be 
most  sanguine  of  the  outcome. 

To  the  rearing  of  a  healthy  child  there 
needs  no  complex  system  of  theory,  but  only 
the  knowledge  and  practice  of  simple  rules  of 
health.  These  it  has  been  the  purpose  of 
Dr.  Hildesheim  to  inculcate,  and  he  has  done  so 
with  a  clearness  and  conciseness  which  will 
make  his  teaching  doubly  valuable  to  all  who 


x        THE  HEALTH  OF  THE  CHILD 

are  interested  in  the  physical  welfare  of 
children.  If  as  sponsor  to  his  book  I  present 
it  without  further  praise,  it  is  because  I  feel 
sure  the  book  itself  will  prove  its  own  best 
recommendation. 

G.  F.  STILL 

March 


CONTENTS 


PAf.K 


INTRODUCTION    by    G.     F.    STILL,    M.D., 

F.R.C.P., vii 

FOREWORD, i 

I.  GROWTH  AND  DEVELOPMENT,      .       .  3 

Changes  at  Birth,  - 3 

Peculiarities  of  the  Infant,   ....  4 
Other  differences  between  the  Child  and 

the  Adult, 6 

Mental  Development,          ...  7 

Weight,        .                         ....  7 

The  Teeth,  .                         ....  8 

II.  THE  HEALTH  OF  THE  CHILD  BEFORE  BIRTH,  14 

III.  FOOD  AND  FEEDING, 17 

Advantages  of  Human  Milk,       .  18 

Causes  for  Hand-feeding,    ...  19 
Details  of  Breast-feeding,    .                          .22 

Hand-feeding,      ......  24 

Faults  of  Hand-feeding,       ....  30 


xii     THE  HEALTH  OF  THE  CHILD 

PAGE 

Patent  Foods,      .         .         .        .                 .  34 

Diet  from  9  months  to  2  years,    ...  37 

Diet  from  2  years  to  4  years,  39 

Diet  of  older  children,          ....  40 

Constipation, 45 

Diarrhoea, 48 

IV.  HYGIENE  OF  THE  NURSERY,       .       .       .  51 

Washing, 51 

Clothing, 54 

The  Nursery, 56 

Exercise, 58 

Rest, 61 

Fresh  Air, 62 

Chill, 64 

Mouth  Breathing, 66 

V.  THE  SICK  CHILD, 71 

When  to  send  for  the  Doctor,      .        .         .  71 

Common  Complaints, 75 

Home  Nursing  and  Household  Remedies  .  83 

Infectious  Diseases  of  Childhood,        .         .  91 

Emergencies, 96 

VI.  TRAINING  THE  CHILD,  .       .       .        ,       .  101 

INDEX, .109 


THE  HEALTH  OF  THE  CHILD 

FOREWORD 

/CLEANLINESS  is  the  key-note  of  success 
^^  in  the  proper  care  of  the  health  of  the 
individual,  as  it  is  in  the  care  of  the  health  of 
the  nation. 

The  achievements  of  modern  surgery  have 
been  made  possible  almost  entirely  by  the 
scientific  appreciation  of  the  significance  of 
cleanliness.  The  same  is  true,  to  a  large  ex- 
tent, of  modern  medicine  as  illustrated  for 
example  by  the  medical  triumphs  which  made 
it  possible  to  construct  the  Panama  Canal.  The 
old  definition  of  dirt  is  matter  misplaced.  But 
from  the  scientific  point  of  view,  a  better  de- 
finition might  be  microbes  misplaced.  Microbes 
are  present  everywhere,  and  many  of  them  do 
very  useful  work.  Others  are  mischievous  if 
they  are  misplaced,  that  is  to  say,  if  they  gain 
admittance  to  some  part  of  the  body  where  they 


2        THE  HEALTH  OF  THE  CHILD 

can  multiply  and  where  their  poisonous  pro- 
ducts can  be  absorbed  by  the  body.  Above 
all,  this  is  true  of  the  microbes  which  are  intro- 
duced with  the  food  during  the  first  year  of  life. 
These  account  for  the  fact  that  between  two 
thousand  and  four  thousand  infants  die  of 
diarrhoea  every  year  in  London  alone. 

But  the  more  one  studies  child-life,  the  more 
one  becomes  impressed  by  the  importance  of 
cleanliness — cleanliness  of  the  body  and  of  the 
clothes  the  infant  wears,  cleanliness  of  the  room 
he  lives  in,  cleanliness  of  the  air  he  breathes, 
and  above  all,  cleanliness  of  the  food  with 
which  he  is  fed. 


GROWTH   AND   DEVELOPMENT 

CHANGES  AT  BIRTH 

DURING  the  nine  months  of  the  child's 
development  in  its  mother's  body  before 
birth,  it  has  been  floating  in  a  sterile  and  warm 
fluid  with  inert  shrivelled  lungs  and  empty 
stomach,  all  its  needs  being  supplied  by  an 
interchange  of  materials  between  its  own  blood 
and  that  of  the  mother.  At  birth,  a  great  re- 
volution occurs.  The  lungs  fill  with  air  and  are 
alternately  expanded  and  relaxed  some  twenty 
times  every  minute.  Food  is  introduced  into 
the  stomach  and  hence  in  future  all  the  needs 
of  the  body  for  nourishment  and  fluid  are  sup- 
plied. There  is  for  the  first  time  a  loss  of  heat 
and  so  the  wonderful  and  complicated  mechan- 
ism comes  into  play  by  which,  whatever  the 
external  temperature,  the  temperature  of  the 
body  remains  constant  within  variations  of  a 
degree  Fahrenheit.  The  senses  receive  stimuli, 


4       THE  HEALTH  OF  THE  CHILD 

solid  bodies  are  encountered,  light  assails  the 
eyes,  noises  assault  the  ears.  Lastly,  the  mouth 
and  bowels,  which  up  to  now  have  been  sterile, 
become  the  habitat  of  a  large  variety  of 
microbes. 

The  readiness  with  which  the  baby  takes  to 
these  changed  surroundings  is  the  first  sign  of  a 
very  encouraging  characteristic  of  infant  life — 
its  remarkable  adaptability,  within  reasonable 
limits,  to  the  most  diverse  conditions. 

PECULIARITIES  OF  THE  INFANT 

The  Need  for  Support. — The  infant  cannot 
support  itself  on  its  limbs.  It  cannot  hold  its 
head  up  until  it  is  4  to  6  months  old. 

It  is  able  to  sit  up  when  from  7  to  12  months 
old. 

It  is  able  to  stand  when  from  10  to  15  months 
old. 

(Note.  These  and  other  dates  at  which  cer- 
tain phenomena  occur  must  be  understood  to 
be  averages.  The  variations  within  the  limits 
of  health  extend  considerably  beyond  the 
average  range.) 

It  is  important  to  realise  that  no  further 
support  than  rest  for  the  body  and  head  is 


GROWTH  AND  DEVELOPMENT       5 

required.  Mothers  are  often  taught  that  the 
binder  supports  the  body  and  prevents  rupture. 
No  such  support  for  the  body  is  called  for. 
(See  remarks  on  binders  under  the  heading  of 
clothing.) 

Limitations  in  Dietary. — The  infant  has  no 
teeth  and  its  jaw  muscles  are  adapted  for  suck- 
ing, not  for  chewing. 

The  digestive  juices  are  such  as  are  necessary 
for  the  digestion  of  milk — not  for  other  diets. 
Thus,  for  example,  the  digestive  juices  in  the 
adult  convert  starch  into  sugar ;  this  the 
infant's  juices  are  unable  to  achieve. 

The  entirely  fluid  diet  and  the  small  stomach 
entail  small  and  frequent  meals.  The  infant 
has  less  resistance  than  the  adult  to  those 
microbes  which  cause  diarrhoea. 

The  infant  is  very  liable  to  vomit  and  it  is 
well  to  consider  the  reasons  for  this. 

1.  The  sudden  flow  of  milk  often  necessitates 
unduly  rapid  swallowing. 

2.  The  sense  of  satisfaction  requires  educa- 
tion, so  that  a  vigorous  child  at  the  breast  is 
apt  to  take  more  than  it  requires.     This  is 
why  '  posseting  '  is  thought  to  be  a  sign  of  good 
health. 


6        THE  HEALTH  OF  THE  CHILD 

3.  A    considerable    quantity    of     air    is 
swallowed  with  the  feed.     By  taking  the  child 
from  the  breast  at  intervals  and  putting  it  in 
a  comfortable  position,  the  air  is  belched  up 
before  the  distress  becomes  so  great  that  the 
whole  feed  is  returned. 

4.  Infants  have  a  great  facility  for  vomiting. 
This  is  a  safeguard  when  the  child  is  healthy, 
a  source  of  danger  in  ill-health. 

OTHER   DIFFERENCES   BETWEEN   THE   CHILD 
AND  THE  ADULT 

It  is  not  altogether  true  that  '  the  child  is 
father  to  the  man/ 

Certain  glands  (for  example,  the  thymus  and 
lymph  glands)  are  active  in  the  child  but  not  in 
the  adult.  With  others  (for  example,  the 
sexual  glands)  the  reverse  is  true. 

There  are  some  diseases  peculiar  to  childhood 
(e.g.  Rickets)  ;  others  are  peculiar  to  adults 
(e.g.  Gout).  Children  are  far  more  susceptible 
to  certain  infectious  diseases.  (A  person  will 
often  say  '  I  have  had  the  ordinary  childish 
complaints/  meaning  chicken-pox,  measles 
etc.).  Lastly,  a  fact  which  seems  very  odd, 


GROWTH  AND  DEVELOPMENT       7 

certain  parasites  (e.g.  threadworms  and  ring- 
worm of  the  scalp)  only  attack  children. 

MENTAL  DEVELOPMENT 

A  child  develops  a  sense  of  touch  and  of 
temperature,  and  distinguishes  between  light 
and  darkness  immediately  after  birth. 

At  about  4  weeks,  it  follows  objects  with  its 
eyes  and  is  easily  disturbed  by  noise. 

At  3-5  months,  it  laughs  aloud. 

At  5-7  months,  it  is  able  to  pick  things  up. 

At  10-15  months,  it  is  able  to  speak  words. 

At  2  years,  it  is  able  to  make  short  sentences. 

WEIGHT 

The  child's  weight  should  be  recorded  once  a 
week  during  the  first  year,  and  once  a  month 
during  the  second  year.  This  record  is  of  the 
greatest  value  as  an  indication  of  the  welfare 
of  the  child.  But  it  must  be  borne  in  mind  : 

1.  That   the   rate   of  increase  varies  very 
widely,  within  limits  of  health. 

2.  That  the  weight  may  remain  stationary 
or  even  decrease  for  a  week  without  giving 
cause  for  alarm.     For  example,  the  nursing 


8        THE  HEALTH  OF  THE  CHILD 

mother  may  be  menstruating  or  the  child  may 
be  teething. 

3.  That  the  weight  may  be  steadily  increas- 
ing though  the  child  may  be  having  a  faulty 
diet.  The  child  will,  in  this  case,  ultimately 
suffer. 

AVERAGE  WEIGHT 

Birth     7  Ibs. 
5  months  7  x  2=14  Ibs. 

1  year       7x3=21  Ibs. 

2  years      7x4=28  Ibs. 
7  years      7x7  =49  Ibs. 

THE  TEETH 

Date  of  Eruption. — This  is  extremely  vari- 
able. It  is  sufficient  to  remember  that  the 
lower  central  incisors  should  be  the  first  to 
appear ;  that  they  should  show  between  the 
4th  and  loth  month,  average  7  months  ;  that 
at  12  months  the  child  should  have  about  8 
teeth  ;  and  that  all  20  teeth  should  be  present 
by  the  time  the  child  is  2  years  old. 

The  permanent  teeth  appear  between  the 
ages  of  6  and  12  years  with  the  exception  of  the 
wisdom  teeth. 


GROWTH  AND  DEVELOPMENT       9 

Effects  of  Teething. — These  are  very  much 
exaggerated  by  the  laity.  They  are  '  the 
refuge  of  the  destitute ' ;  that  is  to  say,  any  un- 
usual symptom,  at  the  age  of  teething,  is  attri- 
buted to  that  cause.  On  the  other  hand,  by  a 
natural  reaction,  the  effects  of  teething  are  apt 
to  be  under-estimated  by  doctors.  Teething, 
more  often  than  not,  causes  some  salivation 
(dribbling),  discomfort,  as  shown  by  the  child 
constantly  putting  its  fingers  in  its  mouth,  and 
loss  of  appetite.  Further,  there  is  reason  to 
suppose  that  in  some  cases  it  produces  an  in- 
creased susceptibility  to  Bronchitis,  Diarrhoea, 
nervous  phenomena  and  skin  eruptions. 

DECAYED  TEETH  (CARIES) 

There  is  a  most  unfortunately  prevalent 
belief  that  it  does  not  matter  for  the  first 
teeth  to  be  decayed.  Nothing  is  further  from 
the  truth,  and  the  subject  is  so  important  and 
so  little  undertood  that  it  must  be  treated  in 
some  detail. 

DANGERS 

i.  Channel  for  Infection. — The  decayed 
teeth  are  a  breeding  ground  for  microbes  and 


io      THE  HEALTH  OF  THE  CHILD 

Tubercle  bacilli  have  been  found  in  them. 
These  microbes  are  carried  from  the  teeth 
into  the  glands  in  the  neck  and  may  thence  be 
distributed  to  other  parts  of  the  body. 

2.  Indigestion,  Anaemia  and  other  constitu- 
tional disturbances  may  be  and  frequently  are 
set  up  by  swallowing  the  microbes  and  their 
products. 

3.  Inflammation  of  the  Gums  maintains  a 
condition  of  chronic  catarrh  of  the  mouth  and 
throat  and  is  a  fruitful  source  of  enlarged 
tonsils  and  adenoids. 

4.  Difficulty  in  chewing  leads  either  to  the 
bolting  of  unchewed  lumps  of  food  or  to  the 
child  subsisting  on  a  pappy  diet ;  in  either  case, 
indigestion  results. 

5.  Pain  which  is  often   considerable   may 
be  a  serious  detriment ;  and  distant  nervous 
phenomena  such  as  headaches  and  fits  have 
been  shown  to  have  their  origin  in  decayed 
teeth. 

6.  Undergrowth  of  the  Jaws  results  from  early 
decay  of  the  milk  teeth.     Hence  there  is  in- 
sufficient space  for  the  permanent  teeth  and 
these,    being    crowded    and   irregular,    decay 
rapidly  in  their  turn. 


GROWTH  AND  DEVELOPMENT     n 

CAUSES 

1.  Faulty  Diet  is  probably  the  chief  cause. 
Too  much  starchy  food  or  too  little  fat  are  the 
chief  causes  of  Rickets,  and  this  disease,  even 
though  present  in  very  slight  degree,  is  fre- 
quently associated  with  teeth  which  become 
very  early  the  site  of  decay.     Then  again,  it  is 
rather  the  modern  fashion,  owing  largely  to  the 
superabundance   of   prepared   artificial   foods 
on  the  market,  to  keep  children  on  a  soft  and 
pappy  diet  which  requires  no  mastication  ;  the 
natural  cleansing  of  the  teeth  and  gums  which 
comes  from  chewing  hard  food  is  therefore 
wanting ;    the  soft  starchy  material  collects 
between  the  teeth  and  in  the  sockets  of  the 
gums,  and  the  products  of  its  decomposition 
produce  erosion  of  the  enamel. 

2.  Heredity  may  be  a  factor.     It  is  possible 
that  there  is  a  tendency  in  some  families  to 
produce  teeth  which  are  peculiarly  subject  to 
decay. 

3.  Lack   of  Attention. — The  importance   of 
scrupulous  cleanliness  follows  from  what  has 
been  said  above  as  to  the  ill  effects  of  food  col- 
lecting about  the  teeth. 


12      THE  HEALTH  OF  THE  CHILD 

PREVENTION 

1.  Dietetic. — The  proper  diet  for  children  is 
described  later.     Here  it  is  sufficient  to  say 
that  as  soon  as  the  child  has  teeth  it  should  be 
given  some  food  which  will  require  their  em- 
ployment.    It  is  a  good  practice  to  give  a  hard 
cabin  biscuit  for  supper.     Fruit  is  very  cleans- 
ing to  the  teeth  and  is  therefore  preferably 
given  at  the  end  of  meals.     Food  should  be 
strictly  interdicted  between  meals,  especially 
the  promiscuous  habit  of  eating  sweets.     There 
is  no  harm  in  such  a  sweet  as  good  chocolate, 
but  it  should  not  be  eaten  at  all  times  and  in 
any  quantity. 

2.  Cleaning  the  Teeth. — There  are  two  im- 
portant things  to  bear  in  mind.     Firstly  that 
brushing  up  and  down  is  more  important  than 
brushing  sideways  though  both  should  be  done. 
Secondly,    that    however    seldom    they    are 
cleaned,  the  cleaning  last  thing  at  night,  after 
supper,  should  never  be  omitted. 

3.  The  Dentist. — Dentists  are  perhaps  not 
altogether  free  from  blame  with  regard  to  the 
general  attitude  of  mothers  on  this  subject. 
But,  undoubtedly  the  best  dentists  recognise 


GROWTH  AND  DEVELOPMENT     13 

its  importance.  It  must  be  remembered  that 
the  slight  filling  that  these  temporary  teeth 
require  does  not  entail  the  agony  that  adults 
are  wont  to  associate  with  the  dentist's  chair. 
Further,  when  the  teeth  cannot  be  filled,  the 
decay  can  often  be  arrested  by  the  painless  use 
of  caustics.  The  great  difficulty  for  the  work- 
ing class  mother  is  the  expense.  The  establish- 
ment of  dental  clinics  throughout  the  country 
cannot,  it  is  to  be  hoped,  be  much  longer 
delayed. 


II 

THE   HEALTH   OF  THE   CHILD 
BEFORE   BIRTH 

DURING  the  nine  months  of  pregnancy, 
the  mother  is  making  a  new  human 
being.  This  is  a  considerable  undertaking. 
The  mother  must,  therefore,  be  especially  care- 
ful about  her  own  health  and  must  have  more 
rest  than  usual.  In  the  case  of  a  busy  woman, 
a  good  many  of  her  usual  activities  must  be 
curtailed.  Nevertheless,  pregnancy  is  a  per- 
fectly natural  condition  and  there  is  no  need 
for  the  mother  to  be  treated  as  an  invalid. 
Little  more  than  ordinary  common  sense  is 
required  as  a  guide  to  the  expectant  mother. 

Indigestion. — Bad  teeth  in  the  mother  prove 
a  fruitful  source  of  trouble  during  pregnancy 
and  should  have  immediate  attention. 

A  certain  amount  of  trouble  with  digestion 
is  the  rule,  and  the  appetite  may  be  very 
capricious.  Usually  there  is  one  time  in  the 

14 


BEFORE  BIRTH  15 

day  when  the  mother  feels  really  hungry  and 
advantage  must  be  taken  of  this  to  make  a 
proper  meal.  The  craving  for  unusual  foods 
may  be  satisfied  within  reasonable  limits,  but 
it  is  a  mistake,  for  instance,  to  indulge  in 
pickles  or  large  quantities  of  vinegar. 

For  the  heart-burn  so  common  at  night,  a 
little  Bi-carbonate  of  Soda  in  water  or  in  the 
form  of  soda-mint  tablets  is  a  great  boon. 

Constipation  is  common.  Plenty  of  fruit, 
cooked  and  raw,  green  vegetables  and  two  or 
three  tumblers  of  water  during  the  day  (hot  or 
cold,  it  matters  not  which)  will  alleviate  it.  A 
dessert-spoonful  of  refined  Paraffin  after  meals 
will  help.  Other  aperients  such  as  Infusion  of 
Senna-Pods  or  some  form  of  Cascara  Sagrada 
may  be  required,  but  a  strong  purge  should 
never  be  taken.  When  the  condition  has  be- 
come severe,  a  simple  enema  is  safer. 

Exercise  and  Rest. — It  is  very  important  that 
a  proper  amount  of  exercise  be  taken  daily  in 
the  fresh  air,  but  the  mother  must  be  very  care- 
ful to  subject  herself  to  no  sudden  strain.  She 
should  not,  for  instance,  push  the  garden  roller, 
open  a  window  that  has  stuck,  or  lift  a  heavy 
child,  or  a  heavy  piece  of  furniture. 


16      THE  HEALTH  OF  THE  CHILD 

She  should  lie  down  every  afternoon,  at  any 
rate  during  the  latter  months  of  pregnancy  and, 
if  she  feels  lazy,  she  must  remember  that  she 
is  doing  good  work  which  will  show  in  due 
course.  To  the  working-woman  this  is  a 
counsel  of  perfection  ;  in  the  factories  there  is 
here  the  opportunity  for  her  more  happily- 
placed  sisters  to  work  for  some  much  needed 
reforms.  Whenever  the  mother  is  resting,  she 
should  have  her  legs  up  to  relieve  the  pressure 
on  the  veins. 

The  Mind. — It  is  more  important  than 
ever  to  keep  one's  mind  in  wholesome  occupa- 
tion and,  by  the  exercise  of  proper  self-control, 
to  remain  calm  and  cheerful.  So-called 
'  Maternal  Impressions  ' — that  is,  a  physical 
defect  or  blemish  in  a  child  resulting  from  a 
shock  or  fright  to  the  mother — have,  in  my 
opinion,  no  foundation  in  fact  and  the  belief 
has  given  rise  to  a  great  deal  of  unnecessary 
apprehension.  But  if  the  mother  worries  and 
frets  unduly  the  value  of  the  nourishment  that 
the  growing  child  is  receiving  will  diminish. 
This  is  obvious  after  birth  when  the  mother  is 
feeding  the  child  and,  though  less  evident,  is 
no  less  true  before  birth. 


Ill 

FOOD   AND   FEEDING 

IF  all  the  babies  of  England  of  to-day  were 
breast  fed  and  only  breast  fed  for  the  first 
eight  months,  the  effect  in  the  course  of  one 
generation  would  be  very  obvious.  There 
would  be  a  tremendous  increase  in  the  number 
of  children  who  survive  the  first  year ;  there 
would  be  an  almost  complete  disappearance 
of  Rickets  and  all  its  associated  conditions — 
there  would  probably  be  a  great  decrease  in 
Tuberculous  diseases  of  children.  Above  all 
there  would  be  a  magnificent  increase  in  the 
number  of  thoroughly  healthy  boys  and  girls, 
and  ultimately  men  and  women,  who  had  not 
had  their  inherent  natural  vitality  sapped 
during  the  first  year  of  life. 

It  is  not  inconceivable,  though  at  present  it 
appears  highly  improbable,  that  some  day 
man  will  be  able  to  improve  upon  Nature,  and 
produce  a  better  food  for  infants  than  their 


i8      THE  HEALTH  OF  THE  CHILD 

mother's  milk.     But  at  present  there  is  nothing 
to  compare  with  it. 

ADVANTAGES  OF  HUMAN  MILK 

There  are  probably  qualities  in  human  milk 
which  we  do  not  at  present  understand  which 
account  in  part  for  the  difficulty  in  replacing 
it  satisfactorily.  We  do  know  that  artificial 
foods  and  boiled  milk  lack  something  that  is 
essential  in  the  diet  of  a  child,  but  what  it  is 
has  not  yet  come  to  light.  The  only  alterna- 
tive in  general  use  to  human  milk  in  the  first 
months  of  life  is  cow's  milk  (goat's  milk  might 
be  more  widely  used  with  advantage)  and  cow's 
milk  is  lacking  in  two  very  important  qualities. 

i.  Digestibility. — Milk  contains  two  pro- 
teids,  one  (Casein)  which  forms  a  curd  in  the 
stomach,  and  another  (Lact-albumin)  which 
remains  in  solution.  Now  the  Casein  is  not 
only  present  in  much  larger  proportion  in 
cow's  milk  than  in  human  milk,  but  further, 
it  forms  a  much  firmer  clot  or  curd  than  does 
human  casein.  For  this  reason  cow's  milk 
requires  to  be  largely  diluted  to  prevent 
curd-indigestion,  and  then  one  is  faced  with 
a  deficiency  of  fat,  sugar  and  tact-albumin 


FOOD  AND  FEEDING  19 

which  have  to  be  made   up  in  one   way   or 
another. 

2.  Cleanliness. — Human  milk,  for  all  practi- 
cal purposes,  may  be  considered  sterile.  Cow's 
milk  on  the  other  hand  collected  under  the  best 
conditions  is  far  from  sterile,  and  under  the 
conditions  of  town  life  is  often  teaming  with  a 
large  variety  of  microbes.  Ten  per  cent,  of 
London  milk  contains  Tubercle  bacilli.  With 
regard  to  the  danger  from  other  microbes,  it  is 
sufficient  comment  to  state  that  of  the  children 
dying  from  diarrhoea  at  Qreat  Ormond  Street 
Hospital,  it  was  found  that  96  per  cent,  were 
hand-fed. 

CAUSES  FOR  HAND-FEEDING 

The  chief  cause  is  unknown.  That  is  to  say, 
a  vast  number  of  mothers  have  not  got 
sufficient  milk  with  which  to  feed  their  babies 
and  the  cause  of  this  is  not  known.  Possibly 
in  animals,  this  condition  is  kept  at  a  mini- 
mum by  a  process  of  natural  selection,  for  it 
is  obvious  that  a  female  who  could  not 
nourish  her  offspring  would  fail  to  leave 
survivors. 

The  mother  working  away  from  home  is  a 


20      THE  HEALTH  OF  THE  CHILD 

fruitful  cause  in  industrial  centres  for  recourse 
to  hand-feeding. 

Fashionable  mothers  often  prefer  to  sacrifice 
the  welfare  of  the  child  to  the  pleasures  of  self- 
indulgence.  Amongst  the  better  -  educated 
classes  this  is  not  however  so  widespread  a 
trouble  as  is  the  fact  that  many  mothers  are 
too  easily  discouraged.  Sometimes  unfortun- 
ately, this  discouragement  comes  from  the 
monthly  nurse.  The  motions  of  a  breast-fed 
baby  are  often  rather  inclined  to  be  loose  and 
green.  Their  appearance  is  quite  often  not  so 
satisfactory  as  in  the  case  of  a  hand-fed  baby. 
It  is  this  which  often  leads  to  the  mistaken 
advice  of  the  nurse.  But  it  need  cause  no 
alarm  if  the  baby  is  not  losing  weight.  Some- 
times the  mother's  nervous  system,  ill-tuned 
to  the  strain  of  modern  life,  is  inadequate  to 
supply  this  function.  Sometimes  the  mother 
tries  to  compromise,  to  satisfy  the  needs  of 
her  baby  and  of  society  and  fails  to  take 
sufficient  rest.  Insufficient  food  for  the  mother 
has  not  so  great  an  effect  on  the  milk  as  is 
often  supposed,  but  overfeeding  sometimes 
defeats  its  own  end  by  upsetting  the  health 
of  the  mother.  Tender  or  ill-developed  nipples 


FOOD  AND  FEEDING  21 

are  often  a  trouble  at  first,  and  are  not  treated 
with  sufficient  patience.  Where  the  mother 
begins  to  feed  the  baby  and  then  desists,  one  of 
two  reasons  is  usually  given. 

1.  '  The  milk  is  not  satisfying  the  baby/    In 
this  connection,  there  are  three  things  to  be 
remembered.     First,  the  cry  of  indigestion  is 
often  mistaken  for  the  cry  of  hunger.     The 
only    safe    criterion    is    the    weight     record. 
Secondly,   one  can  sometimes  manage  quite 
well  for  some  weeks  by  letting  the  baby  have 
both  breasts  at  each  feed.     Thirdly,  where  the 
milk  is  really  inadequate  there  is  no  objection 
to  combined  breast  and  hand  feeding.    Often,  a 
slight  relief  to  the  mother  is  all  that  is  required 
—for  instance,  one  bottle  in  the  afternoon. 
In  other  cases,  the  mother  is  able  to  give  the 
breast  at  night  and  the  bottle  during  the  day. 

2.  '  The    milk    does    not    agree    with   the 
baby/      This   complaint   often   follows   from 
the  mistake  just  mentioned.     The  baby  cries 
because  it  has  some  pain  from  flatulence  or 
constipation,  and  the  mother  thinking  that  it 
is  hungry  feeds  it  again,  thus  aggravating  the 
discomfort  which  she  is  trying  to  relieve.    Regu- 
larity in  feeding  is  of  the  greatest  importance. 


22      THE  HEALTH  OF  THE  CHILD 

An  infant  very  readily  acquires  habits.  It 
should  be  wakened  up  during  the  day  for  its 
feeds,  and  then  soon  acquires  the  habit  of 
waking  at  the  right  times.  It  must  be  re- 
membered that  the  younger  the  infant  the  more 
important  is  breast-feeding,  so  that  there  is  a 
great  gain,  even  if  the  mother  can  only  feed 
the  child  during  the  first  two  months,  in  her 
doing  so.  There  is  a  common  fallacy  that  the 
onset  of  menstruation  is  an  objection  to  the 
continuance  of  breast-feeding.  This  is  not  so. 

DETAILS  OF  BREAST-FEEDING 

During  the  last  month  of  pregnancy,  it  is  a 
good  plan  to  sponge  the  nipples  with  brandy 
or  eau-de-cologne.  The  nipple  should  be 
washed  before  each  feed,  and  after  the  feed  the 
milk  should  be  washed  off  and  glycerine  and 
borax  mixed  with  an  equal  quantity  of  brandy 
applied.  Great  care  should  be  taken  to  hold 
the  breast  back  so  that  the  child's  nostrils  are 
free  while  it  is  sucking.  If  the  flow  is  too  fast 
the  child  should  be  occasionally  withdrawn. 
If  the  nipples  are  tender,  shields  should  be 
used.  The  mother  must  take  sufficient  rest ; 
often  as  soon  as  she  sets  about  her  household 


FOOD  AND  FEEDING  23 

duties  or  satisfies  her  social  calls,  the  supply  of 
milk  diminishes.  At  the  same  time  she  should 
take  some  exercise.  A  very  special  diet  is 
often  unnecessarily  ordered.  All  that  is  re- 
quired is  that,  without  being  so  excessive  as  to 
cause  indigestion,  it  should  be  more  plentiful 
than  usual,  and  the  most  wholesome  way  to 
increase  it  is  to  add  simple  milk  foods  such  as 
gruel.  It  must  be  remembered  that  many 
medicines  are  excreted  with  the  milk.  With 
regard  to  alcohol  it  sometimes  seems  to  have  a 
deleterious  effect  upon  the  milk,  though  many 
mothers  take  a  little  stout  without  any  ap- 
parent bad  results. 

FREQUENCY  OF  FEEDS 

No  hard  and  fast  rule  can  be  applied.  The 
important  things  are  that  whatever  intervals 
are  determined  on  should  be  rigidly  adhered  to, 
and  that  the  changes  which  are  necessary  as 
the  child  grows  older  should  be  introduced 
gradually.  Roughly  the  feeds  should  be, 
during  the  day,  every  2  to  2\  hours  for  the 
first  3  months,  and  subsequently  every  3  hours. 
At  night  the  child  should  be  fed  every  3  hours 
for  the  first  3  months  ;  from  the  4th  month  it 


24      THE  HEALTH  OF  THE  CHILD 

should  be  able  to  go  6  hours  at  night  without 
a  feed,  getting  on  to  9  hours  about  the  6th  oil 
7th  month. 

As  has  been  said,  it  should  be  wakened 
during  the  day  regularly  for  its  feeds,  but 
this  is  not  necessary  at  night. 

HAND-FEEDING 

The  Bottle. — There  is  one  thing  which  chiefly 
distinguishes  the  good  from  the  bad  bottle — 
namely,  the  ease  with  which  it  can  be  cleaned. 
The  '  Little  Folks  '  and  '  Allenbury  '  are  two 
good  types  and  the  former  is  very  cheap. 
These  are  bottles  which  have  an  opening  at 
each  end.  Unfortunately  bottles  with  tubes 
attached  are  still  used  though  the  danger  of 
such  dirt-traps  must  be  evident  to  all.  The 
opening  in  the  teat  should  be  such  that  the 
milk  will  drop  through  very  slowly  when  the 
bottle  is  held  teat  downwards. 

It  has  been  pointed  out  that  the  dangers  of 
cow's  milk  are  its  indigestibility  and  its  ex- 
traneous contents.  The  latter  include — 

1.  Disease  Germs  from  unhealthy  cows. 

2.  Dirt    from    the    cow,    the    milker,    the 
receptacle,    or   the    vehicle    of   transit.     The 
greatest  incredulity  must  be  exercised  with 


FOOD  AND  FEEDING  25 

regard  to  the  statements  of  the  purveyor.  It 
is  not  uncommon  for  bottled  milk  which  is 
guaranteed  to  be  sealed  immediately  on  milk- 
ing, to  be  put  into  the  bottle  at  the  back  door 
of  the  purchaser,  and  the  cap  to  be  taken  out 
of  the  milk-man's  pocket  and  there  and  then 
attached  to  the  bottle. 

3.  Preservatives  may  be  added  to  the  milk 
although  there  is  not  much  evidence  of  any 
wide-spread  danger  from  this  source. 

Nursery  Milk  is  to  be  avoided.  It  is  from  a 
few  cows  instead  of  from  many,  and  is  therefore 
more  likely  to  show  a  wide  departure  from  the 
average  composition.  Sometimes  when  it  is 
from  Jersey  cows  exclusively,  it  is  too  rich  in 
cream. 

Varieties  of  Doctrine. — The  mother  who 
attempts  to  get  a  clear  view  of  all  that  is  taught 
about  the  modification  of  cow's  milk  will  find 
herself  lost  in  a  wilderness  of  contradiction, 
unsupported  hypotheses  and  directions  so 
elaborate  as  to  be  quite  impracticable.  She 
will  seem  to  be  hedged  in  between  alternative 
diseases  whose  very  names  make  her  shudder. 
If  not  Tubercle  and  Diarrhoea  from  new  milk, 
then  Scurvy  from  cooked  milk ;  if  not  Indiges- 
tion and  Marasmus  from  cow's  milk,  then 


26      THE  HEALTH  OF  THE  CHILD 

Rickets  from  artificial  food.  She  will  have  to 
study  percentage  compositions  which  assume 
a  knowledge  of  higher  mathematics.  She  will 
have  to  study  the  large  variety  of  creams  on 
the  market,  and  to  become  familiar  with  the 
characteristics  of  Demerara  sugar,  milk  sugar, 
beet  sugar  and  grape  sugar.  Much  other 
chemical  lore  must  she  attain  before  she  can 
consider  herself  at  home  with  the  subject. 

Here  it  is  proposed  to  give  first  general 
directions  of  the  simplest  sort  and  then  to 
discuss  certain  details. 

GENERAL  DIRECTIONS  FOR  A  WORKING  CLASS 
WOMAN 

Order  ordinary  milk  from  the  cleanest  dairy 
you  know. 

Stand  the  milk  in  a  basin  or  jug,  covered  with 
a  piece  of  clean  paper,  for  one  hour. 

Ladle  off  the  top  part  for  use. 
Add  tap-water  as  follows  : — 

ist  month  i  part  milk,  3  parts  water 
2nd  and  3rd  months  i     ,,      ,,      2     „ 
4th  and  5th        ,,      i     ,,      „      i  part 
6th  and  yth        „      2  parts  „      i     „ 
8th  month  Plain  milk 


FOOD  AND  FEEDING  27 

Add  one  ordinary  lump  of  sugar  to  each  feed, 
a  rather  small  lump  at  first,  a  big  lump  later  on. 

Heat  the  milk  until  bubbles  just  begin  to  rise 
but  not  so  that  it  rises  to  the  boil. 

Give  milk  to  baby  lukewarm.  Do  not  test 
this  by  sucking  but  by  letting  drops  fall  on  to 
front  of  the  wrist. 

Quantity  of  each  meal : 

ist   month  i\ — 2  oz. 

2nd        „  2  — 3  oz. 

3rd        „  3  oz. 

Up  to  end  of  8  months,  add  i  oz.  for  each 
month. 

After  feeding,  turn  teat  inside  out, 
thoroughly  wash  bottle  and  teat  and  keep  in 
clean  water. 

Scald  bottles  once  a  day. 

With  these  general  directions  as  a  basis  we 
can  now  consider  the  matter  in  a  little  more 
detail. 

1.  Make  all  changes  gradually. — The    only 
exception  to  this  is  when  you  have  to  weaken 
the  milk  because  of  vomiting  or  diarrhoea. 

2.  Too  much  or  too  strong  food  is  a  much  more 
common  fault  than  food  too  weak  or  too  little. 


28      THE  HEALTH  OF  THE  CHILD 

3.  Determine  changes  by  (a)  Weight  record. 
(b)  The  motions,     (c)  Signs  of  abdominal  dis- 
comfort,    (d)   General  condition — colour,  firm- 
ness, liveliness. 

In  this  connection  it  must  be  noted  that  the 
deceptive  results  of  patent  food  feeding  is  one 
of  its  worst  features  ;  for  a}  b  and  c  may  all  be 
satisfactory  for  some  time  on  such  a  diet,  whilst 
Rickets  is  gradually  developing.  But  on  cow's 
milk  modified  as  above,  the  weight  record  is  a 
very  reliable  test  of  the  general  condition  and 
progress  of  the  child. 

4.  Curd      Indigestion. — Individual      babies 
differ  very  widely  in  their  ability  to  deal  with 
the  heavy  tough  curd  that  cow's  milk  forms  in 
the  stomach.     Some  babies  appear  to  be  able 
to  digest  plain  undiluted  cow's  milk  from  birth, 
whilst   others   have   trouble   even   when   the 
dilution  is  such  that  the  proportion  of  casein 
present  is  less  than  the  proportion  in  human 
milk.     A    very    simple,    safe    and    effectual 
remedy  for  these  latter  is  to  add  sodium  citrate, 
one  grain  to  each  ounce  of  milk.     The  only 
objection  to  this  modification  is  that  it  is  often 
slightly  constipating. 

5.  The  colour  and  consistency  of  the  motions  is 


FOOD  AND  FEEDING  29 

more  important  than  whether  the  baby  has 
one  or  four  actions  in  the  twenty-four  hours. 
There  should  be  no  hard  lumps,  no  undigested 
curd,  no  mucus  (slime),  no  green  colour. 

6.  If  a  child  is  not  getting  enough  food, 
increase  the  strength  of  the  food  rather  than  the 
bulk. 

7.  Sugar. — Milk  sugar  is  better  than  ordinary 
sugar,  partly  on  the  general  principle  that  one 
should  follow  Nature  as  nearly  as  possible,  and 
partly  because  it  has  a  slight  laxative  value. 

8.  Cream. — China   dishes   can   be   obtained 
with  two  spouts,  one  of  which  runs  to  the 
bottom  of  the  dish.     These  are  very  convenient 
for  separating  off  the  upper  portion  of  the  milk. 
If  '  shop-cream '  is  bought,   it  must  be  re- 
membered that  its  strength  varies  very  con- 
siderably and  that  owing  to  its  concentration, 
it  is  very  easy  to  add  too  much.     It  should  of 
course  be  added  before  scalding. 

9.  The     Diluent.     Barley     water     is     very 
commonly  recommended.     It  is  possible  that, 
to  a  slight  extent,  it  prevents  curd  indigestion, 
but  it  contains  a  small  quantity  of  starch  which 
may  itself  cause  indigestion.     Lime  water  is 
also  popular.     Cow's  milk  contains  a  great 


30      THE  HEALTH  OF  THE  CHILD 

deal  more  lime  than  does  human  milk. 
Nothing  is  better  than  ordinary  water  from  a 
good  supply. 

FAULTS  OF  HAND-FEEDING 

Dirty  milk. — We  are  all  agreed  that  the  milk 
during  the  first  eight  months  should  not  be 
boiled,  but  dangerous  microbes  can  be  killed 
by  a  temperature,  short  of  boiling-point,  which 
does  not  destroy  the  unknown  but  valuable 
constituents  which  are  lost  in  boiled  milk.  If 
this  is  done  more  or  less  accurately  (as  by  an 
Aymard  or  Soxhlet  apparatus)  it  is  called 
Pasteurizing.  Both  the  Aymard  and  the 
Soxhlet  can  be  obtained  readily  and  are  easily 
worked.  One  of  these  or  some  similar  con- 
trivance should  be  used  by  all  mothers  who  can 
afford  them.  Those  who  cannot  should  scald 
the  milk  as  described.  When  you  consider 
that  town  milk  is  often  24  hours  old  before  it 
is  delivered,  that  often  it  is  produced  100  miles 
away  from  the  town,  that  10  per  cent,  of 
London  milk  contains  Tubercle  bacilli,  and 
above  all,  the  figures  of  mortality  from 
diarrhoea  in  infants,  the  reasons  for  this  pre- 
caution become  evident.  Moreover,  the 


FOOD  AND  FEEDING  31 

figures  of  mortality  give  no  idea  of  the  debility 
produced  in  those  who  recover,  and  who  often 
subsequently  succumb  to  some  other  illness 
owing  to  their  weak  state. 

In  spite  of  these  cogent  reasons  for  scalding 
milk,  certain  arguments  have  been  adduced 
against  the  practice  and  these  deserve  con- 
sideration. 

1.  The    possibility    of    destroying    valuable 
qualities. — It  is  suggested  that  as  boiling  the 
milk  has  bad  results  which  are  evident,  heating 
it  to  a  less  degree  may  have  similar  though  less 
evident  results.     This  hypothesis  is  not  sup- 
ported by  experience. 

2.  Destroying  the  microbes  prevents  acquired 
immunity. — The  theory  is  that  the  baby  by 
swallowing  dangerous  microbes  insufficient  in 
number  to  produce  disease  acquires  a  resistance 
to  them  which  is  of  value.     The  answer  is 
two-fold.     First  that  the  immunity  is  acquired 
at  too  great  a  cost.     Secondly,  it  is  not  acquired 
until  the  period  when  it  was  most  needed  has 
passed,  that  is  to  say,  the  period  when  the  diet 
is  milk  only. 

3.  The  alleged  harmlessness  of  Tubercle  bacilli 
from  the  cow. — All  we  can  say  here  is  that  the 


32      THE  HEALTH  OF  THE  CHILD 

weight  of  the  evidence  preponderates  against 
this  view. 

On  paper,  it  appears  safe  to  give  unheated 
milk  where  you  have  a  model  dairy,  an  efficient 
refrigerator  apparatus,  scrupulous  cleanliness 
and  strict  Tuberculin  testing  of  the  cattle. 
But  in  practice  the  difficulty  is  that  the  more 
nearly  perfect  such  a  scheme  is  at  the  onset, 
the  demand  for  the  milk  is  such  that  the 
details  of  organisation  have  to  be  left  in  the 
hands  of  a  large  number  of  people,  and  this 
inevitably  leaves  room  for  mismanagement  and 
carelessness. 

4.  The  milk  is  less  appetising. — In  older 
children,  during  the  second  and  third  year, 
this  is  sometimes  a  slight  drawback,  but  by 
then  milk  is  only  a  subsidiary,  though  still  a 
very  important  article  of  diet. 

My  own  view  therefore  is  that  the  weight 
of  the  evidence  is  overwhelmingly  in  favour  of 
Pasteurizing  the  milk  during  the  first  year  at 
least. 

Too  large  a  quantity  to  each  feed. — This  is  a 
possibility  which,  though  perhaps  not  so 
common  as  some  authorities  hold,  is  apt  to  be 
forgotten.  The  great  ease  with  which  good  or 


FOOD  AND  FEEDING  33 

bad  habits  are  induced  in  infants  must  always 
be  borne  in  mind.  By  making  the  intervals 
between  meals  too  long  or  by  making  the  meals 
themselves  too  weak,  a  larger  bulk  of  food 
than  the  stomach  is  fit  for  is  introduced.  The 
stomach  becomes  dilated,  and  although  the 
child  shows  no  ill  effect  for  a  time,  vomiting 
and  wasting  may  subsequently  ensue. 

Too  much  carbohydrate. — Many  patent  foods, 
advertised  as  containing  no  starch,  contain 
large  quantities  of  what  is  called  '  converted 
starch/  that  is  to  say,  starch  which  has  gone 
through  the  first  step  of  its  change  into  sugar. 
Now  if  you  have  too  much  starch  or  converted 
starch  or  sugar  in  the  feeds,  there  are  direct 
and  indirect  bad  effects.  The  former  are 
flatulence  with  associated  vomiting  and  loose- 
ness of  the  bowels.  The  indirect  effects  are 
apparently  that  the  absorption  of  fat  is  inter- 
fered with  and  are  therefore  the  same  as  those 
produced  by  too  little  fat  in  the  food — namely 
Rickets.  This  is  one  of  the  chief  reasons  for 
insisting  that  patent  foods  should  never  be  used 
as  the  staple  article  of  diet  but  only  as  a  tem- 
porary expedient. 

Too  little  fat. — '  The  chief  dietetic  factor  in 


34      THE  HEALTH  OF  THE  CHILD 

the  production  of  Rickets  is  deficiency  of  fat 
assimilation  '  (Still).  Various  substitutes  for 
cream — such  as  suet — iiave  been  recommended 
but  the  great  advantage  of  the  natural  milk-fat 
is  that  it  is  more  finely  divided  and  more  in- 
timately united  with  the  other  food  con- 
stituents than  any  extraneous  fat  artificially 
mixed  with  the  milk  can  be. 

Too  much  fat. — Babies  have  a  remarkable 
capacity  for  digesting  and  absorbing  fat. 
Nevertheless,  if  the  concentrated  creams  sup- 
plied by  dairies  are  added  to  the  milk,  it  is  very 
easy  to  produce  too  high  a  proportion  of  fat 
with  consequent  indigestion  and  wasting. 

Figures  are  of  little  use  to  those  who  are  not 
trained  to  deal  with  them.  But  it  may  be  well 
to  remind  the  reader  that  cow's  milk  contains 
the  same  proportion  of  fat  as  does  human  milk, 
double  the  quantity  of  proteid  and  about  half 
the  quantity  of  sugar. 

PATENT  FOODS 

Their  name  is  legion,  but  they  fall  into  two 
groups — substitutes  for  cow's  milk  and  additions 
to  cow's  milk.  Many  of  them  have  proved 
highly  valuable  as  temporary  expedients  for 


FOOD  AND  FEEDING  35 

tiding  a  baby  over  a  dangerous  period  when 
its  ordinary  diet  is  unsuitable.  But  it  would  be 
difficult  to  exaggerate  the  amount  of  harm  that 
is  done  by  their  indiscriminate  use.  The  baby 
is  not  getting  on.  The  mother  and  doctor 
between  them  have  tried  in  rather  a  hap- 
hazard way  several  modifications  of  cow's  milk 
with  no  very  satisfactory  results.  A  friend's 
baby  has  been  saved  by  somebody's  food.  The 
food  is  tried.  The  results  fulfil  every  pre- 
diction. The  motions  immediately  improve, 
the  mother  enjoys  the  first  restful  nights  she 
has  had  for  weeks,  the  baby  laughs  and  the 
weight  increases.  It  is  little  wonder  that  so 
satisfactory  a  diet  is  made  a  permanency. 
And  it  is  difficult  to  convince  the  uninitiated 
mother,  six  months  or  a  year  later,  that  the 
trouble  from  which  the  child  is  suffering — 
anaemia,  flabby  muscles,  a  pigeon  chest  or  a 
pot-belly,  croup  or  convulsions,  teeth  that 
decay  as  soon  as  they  appear,  bowed-legs, 
backwardness  in  mental  development  or  what- 
ever it  may  be — is  due  to  the  continued  use  of 
the  food.  These  are  amongst  the  many  mani- 
festations of  Rickets.  There  is  a  prevalent 
belief  that  Rickets  is  a  very  obvious  and  terrible 


36      THE  HEALTH  OF  THE  CHILD 

disease  due  to  gross  mismanagement.  This  is 
an  error.  The  slighter  signs  of  Rickets  are  ex- 
tremely common  amongst  the  babies  of  the 
educated  classes  and  can  only  be  recognized 
as  such  by  those  who  are  familiar  with  the 
disease.  Nor  should  we  say  that  it  is  necessarily 
very  dreadful  for  a  child  to  have  a  very  mild 
form  of  the  disease.  With  appropriate  treat- 
ment the  trouble  can  usually  be  adequately 
dealt  with.  Yet,  even  in  its  mildest  form  it  is 
usually  a  great  hindrance  to  the  proper  develop- 
ment of  the  child.  The  child  will  never  be 
quite  so  fine  a  specimen  of  humanity  as  it  would 
have  been  had  it  been  properly  fed.  And  that 
verdict  when  applied  as  it  must  be  to  many 
thousands  of  the  nation's  children  is  a  very 
serious  indictment  indeed.  Rickets  is  a  pre- 
ventable disease,  and  the  benefit  to  the  nation 
that  would  accrue  from  its  entire  suppression 
would  be  enormous. 

The  other  disease  that  arises  from  the  abuse 
of  patent  foods  is  Infantile  Scurvy.  Many 
people  think  that  this  result  is  surely  prevented 
so  long  as  the  child  is  having  some  unboiled 
milk.  This  is  not  so.  '  A  large  proportion 
of  cases  of  Infantile  Scurvy  arise  when  a 


FOOD  AND  FEEDING  37 

patent  food  is  being  added  to  fresh  milk ' 
(Still).  Now  this  disease  is  not  obvious  to 
those  who  are  not  familiar  with  it  and  it  is 
not  common.  But  the  possibility  must  always 
be  borne  in  mind,  when  we  depart  far  from 
Nature,  that  bad  results  of  a  minor  degree 
may  be  produced,  not  sufficiently  manifest 
for  doctors  to  have  noted  them,  checked  them, 
classified  them  and  named  them,  but  yet  to  be 
avoided  if  possible.  That  is  why  the  practice 
of  giving  some  fresh  food,  even  when  the 
milk  is  only  being  Pasteurized  and  no  patent 
food  is  used,  is  much  in  favour.  Probably  it 
would  be  well  for  every  baby  who  is  being  fed 
on  Pasteurized  milk  to  be  given  some  orange- 
juice  or  grape-juice  from  the  fifth  month,  be- 
ginning with  a  teaspoonful  once  a  day. 

THE  DIET  FROM  9  MONTHS  TO  2  YEARS 

We  cannot  do  better  than  quote  the  admir- 
able words  of  Dr.  Still. 

'  From  nine  months  old  up  to  the  end  of  the 
tenth  month,  an  infant  should  not  have  more 
than  one  meal  a  day  of  starch-containing  food  : 
I  like  Robb's  Biscuits  or  "Malted  Rusks "  for 
a  start,  but  at  this  time  there  is  no  objection 


38      THE  HEALTH  OF  THE  CHILD 

to  any  of  the  partially  malted  cereal  foods  or 
to  the  unconverted  cereal  foods,  only  let  it  be 
quite  clear  that  such  "  foods  "  are  to  be  given 
only  once  a  day. 

'  At  the  age  of  eleven  months  two  starch  con- 
taining meals  can  be  given  in  the  day,  one  of 
which  I  think  may  advantageously  be  a  milk- 
pudding  either  of  pearl  sago  or  ground  rice. 
The  rest  of  the  feeds  are  to  be  milk,  not  less 
than  ij  pints  of  milk  should  be  taken  daily. 
In  addition  the  yolk  of  an  egg  very  lightly 
boiled  should  be  given  daily  from  the  age  of 
nine  months. 

'After  the  age  of  twelve  months  a  dessert- 
spoonful of  gravy  of  fried  bacon  with  a  little 
crumbled  bread  soaked  in  it  makes  a  valuable 
food.  Throughout  the  second  year  it  is  most 
important  that  a  child  should  have  abundance 
of  milk  and  that  the  diet  should  not  be  too 
largely  starch-containing.  Chicken  or  veal 
broth,  fish,  boiled  brains,  red  gravy,  custard, 
blancmange,  all  these  are  useful  as  variations/ 

During  the  second  year,  a  small  portion  of 
potato  may  be  given  daily  with  the  fish  or 
gravy.  Fruit  jelly,  marmalade,  treacle  and 
honey  may  be  used  in  moderation.  Any  green 


FOOD  AND  FEEDING  39 

stuffs  which  will  pass  through  a  sieve,  or  better 
still,  which  have  passed  through  a  sieve,  such 
as  spinach  and  the  flower  of  cauliflower  are 
of  great  benefit.  So  are  baked  apples,  prune 
juice  and  fig  juice. 

DIET  OF  A  CHILD  FROM  2  TO  4  YEARS 

If  a  child  wakes  about  6  and  has  breakfast 
at  8,  it  may  be  given  a  biscuit  or  a  crust  of 
bread  or  some  fruit  on  waking. 

Breakfast  consists  of  porridge  with  milk  and 
sugar  followed  by  a  boiled  egg,  fish  or  bacon- 
fat  with  fried  bread ;  also  bread  and  butter 
with  marmalade,  syrup  or  jam ;  milk  to 
drink. 

Lunch  at  ii.  A  biscuit,  fruit  (apple,  banana, 
orange)  and  water  to  drink. 

Dinner  at  i  or  half-past.  Meat  or  broth  or 
fish  or  poultry.  Green  vegetables  and  potatoes 
— especially  those  boiled  in  their  skins  or 
mashed.  Milk-puddings  and  stewed  fruit, 
bread-and-butter  pudding  or  suet  pudding 
(apple  dumplings,  roly-poly  or  treacle  pudding). 
Water  to  drink. 

Tea  at  4.30  or  5.  Bread  with  butter,  drip- 
ping or  jam,  milk  to  drink.  Simple  cakes  and 


40      THE  HEALTH  OF  THE  CHILD 

occasionally  for  the  older  children,  an  egg  or 
sardine. 

Supper  at  bed-time,  6.30  or  7.  Groats  or 
bread  and  butter  or  rusks  and  milk  or  water  as 
the  child  prefers.  (See  also  p.  43.) 

THE  DIET  OF  OLDER  CHILDREN 

It  is  very  difficult  to  weigh  up  the  pros  and 
cons  of  '  indigestible  '  food,  by  which  is  meant 
not  unwholesome  food  such  as  pastry,  hot 
buttered  toast,  pickles  and  spices,  but  food 
which  leaves  a  large  residue  which  cannot  be 
dissolved  by  the  digestive  juices  and  passes  out 
unchanged  in  the  motion.  Such  are  whole- 
meal bread,  coarse  porridge,  raw  fruits  such  as 
bananas,  apples  and  oranges,  raw  vegetables 
such  as  radishes  and  lettuce  and  some  cooked 
vegetables,  especially  cabbage.  The  stomach 
and  bowel  constitute  from  one  point  of  view 
a  long  hollow  muscle,  and  this  muscle  like  all 
others  requires  exercise  to  keep  it  in  condition. 
It  has  been  shown  that  rabbits  fed  on  food 
from  which  all  the  indigestible  material  has 
been  removed  rapidly  succumb.  It  is  highly 
probable  that  many  of  the  complaints  of  adults 
arise  from  too  pappy  a  diet  during  childhood. 


. 


FOOD  AND  FEEDING  41 

The  bowel  muscles,  insufficiently  stimulated, 
have  become  sluggish  and  enfeebled.  More- 
over it  is  of  the  greatest  importance  for 
the  proper  development  of  the  jaws  and 
teeth  that  the  food  should  require  plenty  of 
chewing.  Finally,  chewing  fruit  pulp  has  a 
very  beneficial  effect  in  cleansing  the  teeth 
and  gums. 

Against  these  arguments  are  first  the  fact 
that  with  the  utmost  patience  and  ingenuity, 
it  is  difficult  to  prevent  some  children  from 
bolting  their  food  and  secondly  the  actual  ex- 
perience of  doctors  that  large  numbers  of 
children  who  suffer  from  colicky  pains  or  who 
pass  motions  containing  mucus  (slime)  or  who 
seem  unaccountably  tired  and  puffy  under  the 
eyes  improve  rapidly  when  put  on  a  diet  in 
which  indigestible  foods  are  avoided.  Colic  is 
a  common  trouble  of  childhood,  and  though  it 
is  often  due  to  constipation,  it  is  sometimes  due 
to  the  food  which  has  been  given  in  the  hope  of 
curing  this  complaint. 

To  sum  up,  indigestible  foods  in  reason — 
raw  apples,  porridge,  bananas,  oranges  and  so 
forth — are  wholesome  and  serviceable.  But 
if  the  child  cannot  be  made  to  chew  properly 


42      THE  HEALTH  OF  THE  CHILD 

or  if  it  show  signs  of  indigestion,  they  should 
be  avoided. 

Idiosyncrasy. — With  certain  articles  of  diet, 
one  child's  meat  is  another  child's  poison. 
This  is  true,  for  instance,  of  eggs,  which  though 
very  suitable  food  for  the  great  majority  of 
children,  invariably  upset  others  even  in  the 
form  of  custard. 

Fad  and  instinct. — This  is  one  of  the  most 
difficult  distinctions  to  draw  correctly.  For 
instance,  a  child  complains  every  time  meat  is 
put  before  it,  and  when  pressed  to  eat  it,  the 
meat  is  packed  in  the  mouth  without  being 
swallowed,  or,  under  extreme  pressure,  is 
swallowed  in  tears  and  presently  returned. 
It  is  difficult  to  believe  that  while  the  child  is 
crying  out  against  the  meat,  its  system  is  cry- 
ing for  the  want  of  it.  This  difficulty  is  most 
marked  when  the  child  is  '  spoiled/  A  spoiled 
child,  like  any  other  damaged  mechanism, 
never  works  smoothly  ;  and  as  a  bad  workman 
blames  his  tools  which  he  has  mishandled,  so  you 
will  hear  the  despairing  mother  of  the  spoiled 
child  declare  '  nothing  pleases  him/  But  if  a 
child  has  been  trained  not  to  make  fusses,  to 
obey  promptly  and  to  take  the  day's  events 


FOOD  AND  FEEDING  43 


cheerily — if  such  a  child  shows  a  strong  re- 
pugnance to  certain  kinds  of  food,  then  it  is 
probable  that  he  is  as  well  or  better  without  it. 
Green  vegetables  seem  to  constitute  a  class  in 
themselves  in  that  the  relish  for  them  appears 
to  be  an  acquired  taste,  and  yet  they  are  uni- 
versally allowed  to  be  a  wholesome  article  of 
diet.  The  best  plan  in  this  case  is  to  insist  on 
a  minute  portion  everyday — just  a  mouthful 
and  presently  it  is  found,  if  this  course  be  per- 
sisted in,  that  the  child  asks  for  more. 

Fat  is  very  good  for  children  in  the  form  of 
butter,  beef-dripping,  and  bacon  fat.  It  is 
partly  on  account  of  the  oil,  that  sardines  are 
a  useful  article  of  diet  for  children. 

Starch  can  be  given  in  excess.  Potatoes, 
bread  and  butter  and  biscuits  are  all  good,  but 
must  all  be  used  in  moderation. 

Feeding  between  meals  should  be  strictly 
forbidden. 

Heavy  suppers  are  bad. — A  substantial  tea 
should  be  followed  by  a  hard  biscuit  and  water 
for  supper. 

Spiced  foods,  pickles,  curries,  tea  and  coffee 
are  bad.  The  best  drink  is  milk  with  a  little 
hot  water  and  sugar ;  cocoa  once  a  day  in 


44      THE  HEALTH  OF  THE  CHILD 

winter ;  tea  and  coffee  will  creep  in  sooner  or 
later,  but  the  later  the  better. 

Cold  meat  and  twice  cooked  meat  cannot  be 
altogether  avoided  in  most  households,  but 
they  should  not  be  given  more  than  about  twice 
a  week. 

Bolting  the  food  can  be  largely  prevented  by 
encouraging  conversation  at  meals.  Nothing 
is  more  characteristic  of  the  perverted  taste  of 
the  early  Victorians  than  the  saying  that  the 
child  should  be  seen  and  not  heard. 

A  child  well  or  ill,  whatever  the  illness,  may 
always  have  as  much  water  as  he  wishes. — It  is 
true  that  it  is  undesirable  to  drink  a  large  bulk 
of  cold  water  very  rapidly.  But  from  this 
small  and  unimportant  fact  has  arisen  an  ex- 
traordinary prejudice  against  the  drinking  of 
cold  water.  The  amount  of  suffering  that  is 
endured  by  children  who  for  one  reason  or 
another  are  feverish,  and  therefore  thirsty, 
but  from  whom  water  is  carefully  withheld,  is 
terrible.  A  child  loses  water  by  the  skin,  the 
lungs  and  the  kidneys  more  rapidly  than  does 
an  adult.  The  child  should  be  encouraged  at 
all  times  to  drink  as  much  water  as  it  will. 
Here  it  may  be  mentioned  that  a  common 


FOOD  AND  FEEDING  45 

trouble  with  children  is  for  the  urine  to  be  too 
concentrated  and  therefore  irritating,  causing 
the  child  to  feel  a  frequent  desire  to  void  it. 
Usually  water  is  then  carefully  withheld  when 
a  free  and  abundant  supply  of  it  is  all  that  is 
required  to  relieve  the  complaint. 

CONSTIPATION  IN  INFANTS 

This  curse  of  civilized  races  is  not  so  common 
in  breast-fed  infants  as  in  those  who  are  hand- 
fed.  Yet  even  in  the  former  it  is  sadly  pre- 
valent. The  causes  are  still  obscure.  At  all 
ages  it  is  of  the  utmost  importance  to  practise 
a  regularity  of  habit.  The  youngest  infant 
should  be  '  held  out '  unfailingly  at  certain 
definite  times.  That  constipation  is  amongst 
the  possible  bad  effects  of  not  letting  the  child 
kick  freely  without  its  napkin  is  dealt  with 
elsewhere  (clothing). 

Symptoms. — Constipation  is  the  chief  cause 
of  flatulence  and  colic  in  infants.  The  colic  is 
either  due  to  the  flatulence  or  directly  caused 
by  the  presence  of  hard  lumps  in  the  bowel. 
In  severe  cases  it  leads  to  vomiting  and  wasting, 
and  then  often  the  mother  confuses  the  cause 
and  result,  and  tells  you  that  the  child  is  pass- 


46      THE  HEALTH  OF  THE  CHILD 

ing  so  little  because  it  takes  so  little.  It  is  a 
common  mistake  to  believe  that  the  motion  is 
merely  the  unabsorbed  remains  of  the  food.  A 
large  part  of  it  is  in  fact  an  excretion  from  the 
lining  of  the  bowel  and  this  excretion  goes  on 
whether  food  is  being  taken  or  not. 

Cure. — The  first  thing  is  to  see  that  the 
proper  food  is  being  given,  especially  that 
there  is  no  deficiency  of  cream.  Manna,  which 
has  an  old  established  reputation,  is  very  dis- 
appointing. Olive  oil  in  small  half  teaspoon- 
fuls  twice  a  day,  is  very  good.  This  is  partially 
absorbed  as  a  food.  The  pure  liquid  paraffin 
of  the  chemists  is  not  absorbed,  and  is  therefore 
in  some  ways  more  efficacious.  Magnesia  is 
an  innocent  and  reliable  remedy.  Dinneford's 
Magnesia  is  a  great  stand-by  during  the  first 
year.  If  these  methods  fail,  medical  advice 
must  be  sought. 

The  orange  juice  which  has  been  recom- 
mended as  a  routine  article  of  diet  after  six 
months  is  slightly  laxative,  and  as  an  alterna- 
tive prune  juice  may  be  tried. 

Castor  oil  is  very  constipating. — A  large  dose 
is  the  safest  purge  we  know  and  is  invaluable 
where  it  is  desired  to  ged  rid  of  any  poison  in 


FOOD  AND  FEEDING  47 

the  bowels  ;  that  is  why  it  is  so  useful  at  the 
onset  of  diarrhoea.  But  one  should  never  try 
to  use  it  as  a  regular  aperient ;  the  child  be- 
comes more  and  more  constipated.  Its  chief 
use  in  babies  is  its  efficacy  in  restoring  the 
motions  to  the  normal  when  they  are  loose  and 
green  and  offensive,  when  administered  in  the 
form  of  a  few  drops  several  times  a  day. 
(Three  drops  with  each  feed  in  a  baby  of  three 
months.) 

Mercury  in  the  form  of  Grey  Powder  or 
Calomel  is  a  very  useful  occasional  aperient, 
especially  when  the  child  is  a  little  '  out  of 
sorts/  but  it  is  best  given  under  doctor's 
directions. 

Enemas. — Six  ounces  of  soapy  water,  a  tea- 
spoonful  of  plain  glycerine  or  a  piece  of  yellow 
soap  shaped  like  the  top  of  one's  little  finger 
are  very  useful  in  an  emergency,  but  as  a 
routine  practice  they  are  bad,  as  the  child 
comes  to  depend  on  this  unnatural  stimulus. 

Older  Children. — Lack  of  exercise,  heavy 
clothing,  bad  teeth  with  consequent  pappy  diet, 
insufficient  water  to  drink,  careless  habits — 
these  are  the  common  errors.  Often  the  child, 
not  understanding  the  importance  of  the 


48      THE  HEALTH  OF  THE  CHILD 

matter,  cannot  be  persuaded  to  make  the  re- 
quisite effort.  In  these  cases,  a  little  moral 
suasion — a  reward  for  success  or  a  deprivation 
for  failure — will  often  work  wonders. 

Paraffin  is  a  harmless  adjuvant  and  is  well 
taken  when  mixed  with  liquid  extract  of  malt. 
It  differs  from  other  aperients  in  that  it  has 
no  chemical  action  but  is  merely  a  lubricant ; 
it  passes  through  the  body  unchanged. 
Aperients  should  not  be  given  casually.  If 
unhappily  they  are  required  the  proper  method 
is  to  give  the  smallest  effectual  dose  regularly 
over  a  prolonged  period. 

Some  form  of  Senna — Senna  pods,  Syrup  of 
Senna  or  Liquorice  Powder  (in  which  the  active 
ingredients  are  senna  and  sulphur) — is  the  best 
stand-by. 

DIARRHOEA 

It  is  to  be  hoped  that  the  appalling  mortality 
of  infants  from  this  complaint  and  its  preven- 
tion by  scrupulous  cleanliness  are  beginning 
to  be  realised  by  the  public.  Unhappily  the 
knowledge  has  not  yet  brought  with  it  any 
general  improvement.  It  is  important  to 
grasp  the  fact  that  the  danger  in  acute 


FOOD  AND  FEEDING  49 

diarrhoea  and  vomiting  is  not  want  of  nourish- 
ment but  lack  of  fluid.  A  child  can  live  for  a 
long  time  on  its  own  tissues,  but  a  minimum 
amount  of  water  in  the  blood  and  tissues  is 
essential  to  life.  Many  a  life  is  lost  through  the 
mother  persisting  with  milk,  where  its  replace- 
ment by  plain  water  would  have  meant  the 
child's  recovery.  It  is  a  good  general  rule, 
whenever  an  infant  ails,  to  dilute  its  feed  at 
once.  With  acute  diarrhoea,  it  is  better  to  put 
the  child  on  to  albumen  water  at  once  (see 
p.  89),  and  obtain  medical  advice.  The 
epidemic  diarrhoea  and  vomiting  appears  in 
the  hot  months  and  is  worst  in  September. 
The  cure  lies  in  the  hands  of  the  doctors  ;  but 
prevention  lies  in  the  hands  of  the  mothers. 
It  is  at  these  times  especially  that  one  cannot 
be  too  watchful  over  the  cleanliness  of  the 
milk  and  of  the  bottle  and  of  anything  which 
may  be  within  the  baby's  reach,  and  is  there- 
fore likely  to  be  put  in  his  mouth.  The  milk 
should  never  be  left  uncovered  ;  it  is  probable 
that  the  house  fly  plays  a  large  part  in  spread- 
ing diseases  of  this  sort.  The  mother  may 
have  an  unhealthy  mouth  and  should  therefore 
never  suck  the  teat  in  order  to  see  whether  it 


50      THE  HEALTH  OF  THE  CHILD 

is  drawing  or  to  taste  the  feed.  The  feed 
may  be  tested  by  pouring  a  little  into  a  tea- 
spoon. If  the  hole  in  the  teat  is  too  small 
it  may  be  enlarged  by  a  needle,  heated  in  a 
flame. 


IV 

HYGIENE  OF  THE   NURSERY 
WASHING 

THE  '  pores  of  the  skin '  are  the  openings 
of  innumerable  glands  which  discharge 
on  to  the  surface  of  the  skin  a  fluid  called  sweat 
or  perspiration.  This  excretion  continues  all 
the  time  but,  for  the  most  part,  evaporates  as 
it  exudes.  It  is  only  when  it  is  poured  out  very 
fast  as  when  one  is  very  hot  that  it  makes  the 
skin  sensibly  moist.  The  presence  of  these 
little  glands  and  their  excretion  is  one  reason 
for  being  very  careful  to  keep  the  skin  clean. 

A  baby's  skin  is  very  apt  to  get  sore  for 
three  reasons — because  it  is  tender,  because 
there  are  many  creases  and  because  it  is  fre- 
quently soiled.  A  large  amount  of  suffering 
is  entailed  upon  babies,  and  a  great  many 
babies  are  dubbed  fretful  or  bad  tempered 
through  lack  of  detailed  attention  to  the  care 
of  the  skin. 

I  cannot  agree  with  those  who  sanction  the 

51 


52      THE  HEALTH  OF  THE  CHILD 

use  of  a  napkin  which  has  been  wet  with  urine 
and  dried  again.  Soiled  napkins  should  be 
put  to  soak  immediately  on  removal,  and 
subsequently  washed  with  soap  and  hot  water. 
The  soap  should  be  thoroughly  removed.  They 
should  be  boiled  twice  a  week. 

Soda  should  never  be  put  into  the  water  in 
which  napkins  are  washed. 

The  water  in  which  a  baby  is  bathed  should 
be  comfortably  warm  ;  if  your  hands  are  not 
very  sensitive  the  elbow  should  be  used  to  test 
it.  It  is  not  desirable  to  insist  upon  the  use 
of  a  thermometer.  Scientific  accuracy  is  excel- 
lent ;  but  a  '  counsel  of  perfection '  often 
means  to  overburden  and  harass  the  conscien- 
tious mother  whilst  the  one  with  less  scruples 
turns  a  deaf  ear  to  all  advice  and  trusts  to  the 
teachings  of  tradition. 

It  is  quite  enough  to  sponge  the  baby  with 
water  in  the  morning  and  use  soap  at  night  ; 
the  points  of  importance  are  that  the  soap 
should  be  a  sound  '  superfatted '  soap  and 
that  it  should  be  well  washed  off.  The  greatest 
care  should  be  taken  to  clean  in  the  folds  and 
creases,  especially  in  the  groins  and  behind  the 
ears,  and  to  see  that  these  parts  are  thoroughly 


HYGIENE  OF  THE  NURSERY      53 

dry  and  that  they  are  then  well  powdered. 
Equal  parts  of  starch  and  boracic  acid  make 
an  excellent  powder. 

There  is  a  tendency  nowadays  to  do  too 
much  cleaning  of  the  nose  and  mouth.  Poking 
things  up  the  nose  may  easily  damage  the 
delicate  structures  therein.  A  hfcalthy  t>aby 
\vho  is  not  allowed  to  suck  dirty  things  does 
not  get '  thrush  '  whether  his  mouth  is  cleaned 
or  not. 

If  any  soreness  of  the  buttocks  appears, 
as  may  happen  with  the  most  careful  nurses, 
the  application  of  a  little  boracic  vaseline  or 
Fuller's  earth  cream  will  often  check  it. 

An  interval  of  an  hour  should  elapse  between 
an  infant's  bath  and  its  last  feed. 

Cold  sponging  should  be  begun  when  a  child 
is  three  or  four,  letting  him  or  her  stand  in 
warm  water  at  first ;  if  he  is  a  vigorous  child, 
the  warm  water  can  soon  be  stopped. 

Cold  baths  have  an  excellent  bracing  effect. 
A  mother  often  wonders  if  her  child  is  strong 
enough  for  cold  baths.  The  answer  is  that 
if  the  child  is  warm  and  comfortable  as  soon 
as  he  has  had  a  rub  down,  all  is  well ;  but  if  he 
is  blue  and  shivering  for  some  time  after  his 


54      THE  HEALTH  OF  THE  CHILD 

bath,    it    should    be     replaced    by    a    tepid 
sponge. 

Scurf  is  best  treated  by  the  use  of  rain  water, 
a  superfatted  soap  and  as  little  as  possible  of 
it  and  the  application  of  the  chemist's  pure 
liquid  paraffin. 

CLOTHING 

Clothes  are  for  warmth,  not  for  support. 

The  essentials  are  that  the  clothes  should  be 
light,  they  should  completely  cover  the  body  and 
limbs,  they  should  be  absorbent,  they  should  be 
free  from  all  constrictions,  they  should  be  easily 
put  on  and  removed,  and  they  should  be  of  as 
little  bulk  as  possible  to  permit  of  the  free 
movements  of  the  limbs. 

As  soon  as  the  cord  is  off,  the  binder  should 
be  discarded  and  a  deep  knitted  woollen  belt 
replace  it. 

It  is  difficult  to  speak  with  moderation  of 
the  enormous  amount  of  suffering  that  ensues 
from  the  use  of  the  traditional  binder.  Over 
and  over  again  one  sees  an  unhappy  infant  so 
constricted  in  its  many  folds  that  one  cannot 
get  one's  fingers  between  the  flannel  and  the 
skin.  One  is  told  that  it  is  '  for  support/  or 


HYGIENE  OF  THE  NURSERY       55 

by  the  more  learned  '  to  prevent  rupture/  A 
baby  does  not  require  support  and  a  properly 
constructed  baby  needs  no  application  to  pre- 
vent rupture.  If  there  is  a  protrusion  at  the 
navel,  after  the  cord  has  come  off,  a  boiled 
penny  in  a  piece  of  clean  flannel  secured  by 
some  small  strips  of  '  zinc  strapping  '  and  kept 
in  place  for  a  few  weeks  is  all  that  is  required. 

It  is  much  more  common  to  burden  the 
baby  with  too  many  clothes  than  the  reverse 
fault  of  letting  it  wear  too  few. 

The  napkin  should  have  as  little  bulk 
as  possible.  A  healthy  naked  infant,  when 
awake,  kicks  up  and  down  all  the  time  with 
great  vigour.  This  kneads  and  shakes  up  the 
abdomen  and  is  an  effectual  aid  to  the  healthy 
action  of  the  bowels.  With  a  thick  wad  of 
napkin  between  the  thighs  and  abdomen,  this 
important  gymnastic  is  quite  impossible.  It 
is  therefore  very  desirable  to  let  the  baby  lie 
totally  naked  in  a  sufficiently  warm  place  for 
some  ten  minutes  or  so,  two  or  three  times  a 
day.  It  is  probable  that  the  lack  of  this 
'  auto-massage  '  accounts  in  part  for  the  pre- 
valence of  constipation  in  civilized  infants. 

In  older  children  (up  to  three  years  of  age, 


56      THE  HEALTH  OF  THE  CHILD 

or  if  the  child  be  at  all  delicate,  throughout 
childhood)  the  half-bare  leg  is  to  be  deprecated. 
It  is  true  that  long  stockings  require  much 
darning  about  the  knees  and  entail  the  use  of 
some  sort  of  suspender.  But  these  dis- 
advantages do  not  outweigh  the  benefit  of  a 
proper  covering.  In  hot  weather,  shoes  and 
stockings  may  be  discarded  altogether.  This 
is  a  great  joy  to  the  child  and  allows  the  free 
use  of  the  foot-muscles.  To  poor  mothers  it 
saves  considerable  expense.  The  foot  gear  is 
of  the  greatest  importance.  Ill-fitting  shoes 
not  only  produce  ugly  and  uncomfortable  feet 
with  corns  and  bunions  and  hammer-toes  in 
the  years  to  come,  but  the  discomfort  of  the 
child  checks  its  natural  impulse  to  race  about 
and  thus  adequately  exercise  its  body.  Pro- 
perly fitting  shoes  well  repay  any  extra  cost 
and  trouble  there  may  be  in  getting  them. 

THE  NURSERY 

The  best  day  nursery  is  the  garden  in  fine 
weather,  the  verandah  or  open  shelter  in  wet. 
In  connection  with  schools  and  creches  there  is 
scope  for  great  development  in  these  directions. 
The  nursery  proper  should,  if  possible,  face 


HYGIENE  OF  THE  NURSERY      57 

south  and  have  large  windows.  Sunshine  is 
not  only  cheering,  it  probably  has  other  im- 
portant effects  on  our  well-being  of  which  at 
present  we  have  very  little  definite  knowledge. 
An  ordinary  fire  is  by  far  the  best  way  of  heat- 
ing the  room.  Gas  stoves  and  even  the  most 
modern  gas  fires  are  very  objectionable.  It 
would  seem  scarcely  necessary  to  mention  the 
fire-guard  were  it  not  for  the  enormous  number 
of  deaths  from  fire  that  still  occur  amongst 
young  children.  There  should  be  as  little 
furniture  as  possible,  simple,  strong  and  free 
from  sharp  points  and  angles,  and  some  baby 
chairs  which  the  children  can  move  about 
themselves.  Keeping  the  toy  cupboard  tidy 
is  one  of  the  first  steps  in  the  child's  education. 
Whenever  anything  is  bought  for  the  nursery 
you  should  consider  first,  is  it  easy  to  keep 
quite  clean,  secondly  is  it  durable,  and  thirdly 
is  it  pleasing  to  the  eye  ?  The  best  thing  for 
the  floor  is  cork  lino  with  one  or  two  large 
washable  rugs  or  mats  ;  and  for  the  walls,  one 
of  the  various  washable  distempers.  What- 
ever the  other  toys  are  there  should  always  be 
a  blackboard  with  chalks  and  plenty  of  large 
wooden  blocks  for  building. 


58      THE  HEALTH  OF  THE  CHILD 

EXERCISE 

Most  people  know  in  a  vague  sort  of  way 
that  exercise  is  good  for  the  circulation,  ex- 
pands the  lungs  and  keeps  the  liver  in  order. 

But  it  does  much  more  than  this. 

1.  It  is  the  chief  source  of  the  body  heat. — If 
the  child  does  not  romp  about  because  the 
clothes  are  too  heavy  or  for  any  other  reason, 
he  does  not  lose  so  much  heat,  and  does  not 
form  so  much  heat,  and  therefore  the  chemical 
activities  of  the  body  are  not  so  great  as  they 
should  be.     In   other  words  the  child  lacks 
vitality  and  vigour. 

2.  There  are  two  fluids  circulating  in  two 
distinct  systems  of  tubes  throughout  the  body. 
One  is  the  blood  which,  as  every  one  knows,  is 
pumped  through  the  blood-vessels  by  the  heart. 
The  other  is  the  lymph  which  circulates  through 
tubes  known  as  the  lymphatic  vessels.     The 
circulation  of  the  lymph  is  of  the  greatest  im- 
portance, and  it  is  maintained  entirely  by  the 
movements  of  the  muscles,  that  is  to  say,  by 
exercise. 

3.  The  regularity  of  the  bowels  is  affected 
directly  and  indirectly  by  exercise  ;    directly 


HYGIENE  OF  THE  NURSERY      59 

by  what  has  been  described  in  the  chapter  on 
clothing  as  '  auto-massage/  and  indirectly  by 
maintaining  the  vigour  of  the  abdominal 
muscles  and  by  preventing  the  lethargy  which 
derives  from  the  accumulation  of  waste  pro- 
ducts in  the  muscles. 

4.  The  development  of  the  bones  depends  on 
the  development  of  the  muscles  working  them. 
Plenty  of  exercise  means  good  firm  muscles 
and  a  strong  frame-work  of  bones.  It  is 
obvious  that  this  is  a  good  object  to  achieve ; 
but  its  prime  importance  is  only  realised  when 
one  remembers  that  the  most  important  part 
of  the  blood  (the  red  blood  cells) — is  formed  by 
the  bone-marrow.  Healthy  blood  depends 
amongst  other  things  on  healthy  bones,  healthy 
bones  depend  on  healthy  muscles,  healthy 
muscles  depend  on  freedom  of  the  limbs  and 
the  opportunity  of  playing  in  the  open 
air. 

An  infant  should  not  be  persuaded  to  stand 
or  walk  before  it  shows  a  desire  to  do  so  ;  nor 
should  it  be  discouraged,  however  early  its  first 
voluntary  efforts  are  made. 

It  is  very  important  to  realise  that  a  child 
never  gets  bent  legs  if  it  does  not  suffer 


60      THE  HEALTH  OF  THE  CHILD 

from  Rickets.  So  that  there  is  never  any 
need  to  check  a  healthy  child  from  running 
about. 

Hoops,  spinning  tops,  skipping  ropes  and 
roller  skates  are  excellent.  So  are  tricycles 
and  bicycles,  but  there  is  a  great  tendency  for 
these,  especially  bicycles,  to  be  used  too  much. 
Bicycling  is  a  wholesome  pastime,  if  the 
machine  fits  the  child,  the  child  sits  up  properly 
and  is  not  persuaded  to  try  and  keep  up  with 
his  elders.  But  in  many  cases  it  altogether 
replaces  walking,  and  this  is  very  undesirable. 
Walking  is  going  out  of  fashion,  but  there  is 
nothing  better  than  a  good  long  tramp  in  the 
country  for  people  of  all  ages  from  five  or  six 
upwards.  All  healthy  children  should  be 
taught  to  swim.  All  boys  should  be  en- 
couraged to  become  boy  scouts.  Mothers  often 
wonder  whether  their  boys  are  not  over- 
exerting themselves  and  getting  too  tired.  The 
only  danger  of  this' is  in  the  case  of  a  boy  com- 
peting (as  in  school  sports,  cross-country 
running  and  so  forth)  against  boys  who  are 
older  or  stronger  than  himself. 


HYGIENE  OF  THE  NURSERY      61 

REST 

Nothing  is  more  deleterious  to  a  child  than 
insufficient  rest.  Children  are  like  the  young 
of  other  animals — there  is  a  natural  alternation 
of  periods  of  ebullient  energy  with  periods  of 
complete  relaxation.  The  unwilling  walk  along 
paved  streets  between  monotonous  rows  of 
villas  is  a  terrible  infliction  on  childhood.  It  is 
only  in  the  playground  or  the  garden  that  the 
child's  natural  energies  are  awakened.  There 
he  romps  until  he  is  healthily  tired,  and  then 
he  should  be  encouraged  to  rest. 

Up  to  the  age  of  seven,  a  child  should  lie 
down,  preferably  in  the  latter  part  of  the 
morning  for  an  hour  or  so.  At  all  times  he 
should  be  given  the  opportunity  to  rest  when 
he  feels  disposed  to. 

At  the  approach  of  puberty,  girls  are  apt  to 
develop  slight  lateral  curvature  of  the  spine 
owing  to  weak  back  muscles  being  inadequate 
to  bear  the  rapidly  increasing  weight  of  the 
breasts.  This  trouble  is  prevented  by  resting 
an  hour  or  two  during  the  day,  and  strengthen- 
ing the  muscles  by  outdoor  games,  skipping, 
dancing,  etc. 


62      THE  HEALTH  OF  THE  CHILD 

FRESH  AIR 

It  must  be  clearly  understood  that  fresh  air 
means  something  more  than  clean  air.  Clean 
air  is  of  the  utmost  importance.  The  air  of  a 
room  in  which  a  number  of  people  have  been 
present  with  closed  windows  smells  foul  and 
the  effect  of  this  smell  is  depressing  ;  whether 
there  are  any  poisonous  gases  present  is  still 
a  matter  of  doubt.  It  has  been  abundantly 
proved  that  microbes  may  be  air-borne  ;  this 
is  especially  true  of  consumption.  But  there 
is  something  more  than  cleanliness  that  gives 
fresh  air  its  peculiar  value  ;  this  factor  appears 
to  be  that  the  air  is  in  motion.  Probably  the 
minute  currents  and  variations  of  tempera- 
ture in  the  air  as  it  strikes  on  the  face  have  a 
bracing  effect.  But  whatever  the  cause  it  is 
certain  that  pure  stagnant  air,  that  is  to  say, 
air  which  has  been  filtered,  warmed  and 
moistened,  even  though  it  may  be  moving  in 
bulk,  but  in  which  there  is  no  commotion,  is 
very  depressing.  This  explains  the  inadequacy 
of  open  doors  to  bedrooms  in  place  of  open 
windows.  The  air  in  the  lobby  may  be  pure 
enough  but  it  is  stagnant.  The  air  out  of 


HYGIENE  OF  THE  NURSERY      63 

doors  is  in  constant  motion.  The  fresh  air 
treatment  has  acquired  its  reputation  in  con- 
nection with  consumption.  It  is  equally 
advantageous  for  other  diseases.  But  it  is 
when  one  has  learnt  that  it  is  equally  important 
for  health  that  one  has  grasped  its  true  signifi- 
cance. There  are  many  degrees  of  health. 
A  child  is  often  poorly,  languid,  apathetic  and 
so  forth  without  being  ill.  For  a  child  to  be 
in  first-rate  health,  '  the  top  of  its  form/  it 
must  lead  the  fresh  air  life,  day  and  night. 

Insufficient  warmth  to  the  body  is  no  part  of 
the  treatment.  If  a  child  is  sleeping  out  on 
a  balcony,  it  must  have  sufficient  clothing 
and  if  necessary  hot  bottles  to  ensure  its 
comfort. 

On  the  other  hand,  great  cold  is  no  bar  to 
this  method  of  living.  In  the  most  extreme 
cold  (in  this  country)  the  body  can  with  due 
care  be  kept  sufficiently  warm.  The  air  that 
is  breathed  is  warmed  in  the  nose  before  it 
reaches  the  lungs. 

'  Open  windows '  does  not  mean  a  gap  of 
one  inch  at  the  top  of  the  window  and  a  blind 
and  heavy  curtain  over  it. 


64      THE  HEALTH  OF  THE  CHILD 

CHILL 

Every  one  knows  that  a  chill  is  often  followed 
by  illness ;  the  ordinary  name  for  a  very 
common  disease,  '  catching  cold/  illustrates 
this.  It  is  true  that  its  frequency  is 
exaggerated.  This  is  because  at  the  onset  of 
fever  it  is  usual  to  feel  cold  and  shivery,  and 
it  is  supposed  from  these  sensations  that  the 
patient  has  been  unduly  exposed  in  some  way. 
Nevertheless  it  is  indisputable  that  to  get 
soaked  in  the  rain  and  then  take  a  railway 
journey  in  your  wet  clothes,  for  example,  is 
to  court  disaster.  Now  there  is  a  great  deal 
of  mystery  about  this  word  chill,  and  it  is 
worth  while  clearing  up  the  matter.  Many 
people  think  that  doctors  contradict  them- 
selves when  they  recommend  fresh  air  and 
warn  you  against  chills.  The  body  tempera- 
ture is  maintained  by  a  balance  of  heat  pro- 
duction and  heat  loss.  The  heat  is  produced 
chiefly  by  the  muscles  (flesh).  Living  muscle 
even  at  rest  is  always  in  a  state  of  slight  con- 
traction (tone).  This  tone  is  the  source  of 
heat  when  the  body  is  at  rest.  When  the 
heat  loss  increases,  the  tone  increases  to  keep 


HYGIENE  OF  THE  NURSERY       65 

up  the  balance.  We  all  recognize  that  we  are 
braced  up  in  cold  weather  and  lax  in  hot 
weather.  When  the  heat  loss  increases  further 
the  individual  feels  a  desire  to  move  about,  to 
run  about  or  swing  his  arms.  If  he  cannot 
move  about,  then  he  shivers  involuntarily. 
This  variation  of  heat  production,  as  required, 
depends  on  impulses  coming  to  the  nerve- 
centres  from  all  parts  of  the  body. 

There  are  two  ways  in  which  a  chill  is 
produced. 

First :  When  the  natural  tendency  to  move 
about  is  forcibly  checked,  e.g.  sitting  still  in 
wet  clothes. 

Secondly  :  When  the  balance  is  upset  by 
one  small  area  of  the  body  being  cold  whilst 
the  rest  is  warm,  e.g.  wet  feet  or  sitting  in  a 
draught. 

It  has  been  proved -that  animals  with  wet 
feet  lose  their  resistance  to  microbes  which 
they  ordinarily  are  able  to  resist.  So  the  child 
with  wet  feet  loses  its  powers  of  resisting  the 
microbe  which  causes  catarrh  of  the  nose ;  in 
other  words,  it  catches  a  cold. 

The  cure  for  a  draught  is  not  to  shut  the 
window  but  to  open  it  wide.  Then  the  draught 


66      THE  HEALTH  OF  THE  CHILD 

is  converted  into  a  breeze,  the  whole  body  is 
affected  by  the  altered  atmospheric  conditions 
and  responds  accordingly. 

MOUTH  BREATHING  ('  Tonsils  and  Adenoids') 

The  throat  has  four  openings — the  nose  and 
mouth  separated  by  the  palate  open  into  it  in 
front,  while  below  it  is  continuous  with  the 
wind-pipe  and  gullet.  Tonsils  and  Adenoids 
are  present  in  all  children.  It  is  only  when 
they  are  unduly  large  that  they  obstruct  the 
passage  of  air  from  the  nose,  through  the 
throat,  into  the  wind-pipe.  The  child  is  then 
compelled  to  keep  its  mouth  open.  It  is  still 
a  much  debated  point  whether  the  tonsils  and 
adenoids  serve  any  useful  purpose.  It  is  a 
mistake  to  assume  because  the  use  of  an  organ 
is  not  known  that  it  has  none.  Nor  is  this 
proved  even  by  the  fact  that  its  removal  has 
no  evident  bad  effect.  Nevertheless  the  vast 
experience  of  the  removal  of  tonsils  and  ade- 
noids that  has  accumulated  points  quite  un- 
mistakably to  the  fact  that  where  they  are 
diseased  or  so  enlarged  as  to  cause  serious 
obstruction  to  proper  breathing,  they  are  best 
dealt  with  by  operative  measures. 


HYGIENE  OF  THE  NURSERY      67 

Causes  of  enlargement. — We  are  much  in  the 
dark  about  this.  It  has  often  been  suggested 
that  our  damp  climate  is  a  factor.  Un- 
doubtedly a  fruitful  cause  is  dental  caries. 
The  decayed  teeth  keep  up  a  state  of  inflam- 
mation of  the  gums  which  in  turn  leads  to  a 
chronic  catarrh  of  the  throat. 

Results  of  enlargement. 

1.  Under-developed    nose. — The    face    of    a 
child  with  severe  nasal  obstruction  is  readily 
recognized.     The  little  muscles   of  the  nose 
which  keep  the  nostrils  expanded  and  enable 
them  to  withstand  the  indraught   from  the 
lungs  with  each  breath  that  is  taken  are  never 
exercised  and  so  the  nose  does  not  grow.     A 
number  of  cavities  in  the  skull  open  into  the 
nose  ;  and  when  the  latter  is  small  and  pinched, 
these  cavities  become  unhealthy  ;   hence  there 
are  frequent  headaches  and  a  feeling  of  languor 
and  heaviness  of  the  head  which  hinders  the 
mental  growth. 

2.  Under-developed  jaw. — The  mouth  being 
always  open,  the  jaw  muscles  and  jaws  do  not 
grow  properly,  so   that  there   is   insufficient 
mastication   of   the   food   and   crowded   per- 
manent teeth. 


68      THE  HEALTH  OF  THE  CHILD 

3.  Under  -  developed    chest.  —  This    is    very 
serious.     The  muscles  of  the  chest  which  are 
used  in  breathing  have  less  resistance  to  work 
against,  having  to  draw  the  air  through  the 
mouth  instead  of  through  the  narrow  passages 
of  the  nose.     Hence  arises  a  poor  flat  chest  and 
round  shoulders. 

4.  The  air  in  the  lungs  has  not  been  filtered, 
warmed  and  moistened  by  its  passage  through 
the  nose. 

5.  The  secretions  at  the  back  of  the  nose  and 
throat  stagnate  and  become  a  breeding  ground 
for  microbes.     The  child  gets  repeated  sore 
throats,  bronchial  catarrh  and  enlarged  glands 
in  the  neck. 

PREVENTION  AND  CURE 

The  '  comforter '  will  probably  never  be 
abolished,  and  its  sins  have  often  been  con- 
siderably overstated.  Nevertheless  there  can 
be  no  doubt  that  it  is  better  to  do  without  it, 
and  if  it  is  used  in  emergencies,  it  should  never 
be  left  for  long  periods  in  the  baby's  mouth, 
and  the  utmost  care  should  be  exercised  to 
keep  it  clean. 

A   mother   should   watch   the   baby   when 


HYGIENE  OF  THE  NURSERY      69 

asleep.  Often  with  an  infant  the  mouth 
can  be  closed,  and  kept  closed  by  propping  the 
bed-clothes  under  it.  The  child  must  be  en- 
couraged to  keep  its  mouth  shut  when  awake. 
The  teeth  must  be  carefully  watched  (see  p.  9). 
Breathing  exercises  should  be  a  part  of  the 
routine  discipline  of  every  child.  Breathing 
exercises  are  very  simple.  For  instance,  the 
child  stands  facing  you  with  its  arms  straight 
out  before  it,  palms  together.  The  arms  are 
slowly  separated  until  they  are  in  a  line  with 
the  shoulders,  whilst  a  long  deep  breath  is 
taken  in  through  the  nose.  The  arms  are  then 
dropped  to  the  sides  while  the  breath  is  let  out 
through  the  open  mouth.  Another  method  is 
as  follows.  The  arms  are  straight  down  by 
the  sides,  palms  backwards,  mouth  closed. 
The  arms  are  slowly  turned  round  (everted) 
so  that  the  palms  face  forwards  whilst  a  deep 
breath  is  taken  through  the  nose.  Then  they 
are  allowed  to  drop  back  again  into  the  natural 
position  while  the  breath  is  let  out  through  the 
open  mouth.  The  child  should  have  nothing 
on  the  chest  but  a  thin  vest,  so  that  the  teacher 
can  see  that  the  chest  is  really  filling  with  air. 
This  can  be  further  ascertained  by  the  teacher 


70      THE  HEALTH  OF  THE  CHILD 

placing  the  hands  on  the  lower  part  of  the 
chest. 

The  child  should  not  be  allowed  to  raise  its 
shoulders  while  breathing  in.  The  aim  of 
breathing  exercises  is  first  to  teach  the  child 
to  breathe  through  its  nose,  and  secondly  to 
increase  the  mobility  of  the  chest ;  in  other 
words  the  difference  in  its  size  during  breathing 
in  and  breathing  out.  It  is  important  to  note 
this,  because  it  is  sometimes  mistakenly 
thought  that  these  exercises  aim  at  producing 
a  big  chest.  The  growth  of  the  chest  is  the 
proper  response  to  the  more  general  exercises 
which  a  healthy  child  naturally  takes.  If 
nasal  obstruction  is  present  or  the  tonsils  are 
causing  trouble  of  any  other  sort,  professional 
advice  should  not  be  delayed.  Here  it  is 
sufficient  to  express  the  view  that  there  are 
slight  cases  where  syringing  the  nose,  breath- 
ing exercises  and  other  such  measures  are 
sufficient,  and  that  there  are  many  other  cases 
in  which  operative  measures  offer  the  best 
chance  for  the  child's  proper  development. 


THE  SICK  CHILD 
WHEN  TO  SEND  FOR  THE  DOCTOR 

THE  practice  of  trying  in  a  book  to  teach 
mothers  all  the  symptoms  and  the 
proper  treatment  of  grave  diseases  is  a  mistake. 
The  sensitive  mother  is  terrified  at  the  horrible 
prospects  which  are  opened  up,  and  the 
sensible  mother  when  the  grave  condition 
arises  depends  on  her  medical  adviser.  It  is 
bad  to  send  for  the  doctor  for  every  slightest 
deviation  from  health  ;  the  human  organism 
is  a  very  complicated  machine  and  one  can 
scarcely  expect  it  always  to  run  quite  smoothly, 
also  a  baby  that  is  ill  tends  to  right  itself  like  a 
ship  on  a  stormy  sea.  Further,  experience  will 
familiarize  a  mother  with  the  aspects  of  many 
minor  ailments,  and  the  way  to  deal  with  them. 
But  for  the  young  mother  it  is  better  to  send 
for  the  doctor  too  often  than  not  often  enough. 
There  are  very  many  conditions  of  which  it  is 

71 


72      THE  HEALTH  OF  THE  CHILD 

very  difficult  for  the  layman — and  often  for 
the  doctor  too — to  say  at  first  whether  they 
are  quite  trivial  or  very  serious.  Such  as,  for 
instance,  sudden  stomach-ache,  ear-ache,  sore 
throat,  a  limp  or  high  fever.  And  in  many 
such  cases,  it  is  of  great  advantage  to  the 
doctor  to  see  the  child  at  the  onset  of  the 
trouble.  So  that  the  following  observations 
will  only  deal  with  those  conditions  which  can 
be  safely  dealt  with  by  the  mother  or  which 
are  so  sudden  that  some  treatment  is  called  for 
before  the  doctor's  arrival. 

THE  MOTIONS 

A  mother  should  always  observe  the  motions 
of  a  child  until  it  is  of  an  age  to  tell  her  when 
it  is  constipated.  Apart  from  this  trouble, 
many  a  clue  can  be  gained  by  the  daily  in- 
spection ;  the  presence  of  curds  of  milk,  of 
undigested  vegetable  fibre,  of  mucus,  of  blood 
and  of  worms  all  tell  their  tale.  Thread- 
worms are  like  little  bits  of  white  thread 
wriggling  about,  and  are  always  on  the  outside 
of  the  motion  and  therefore  easily  seen.  Other 
sorts  of  worms  are  less  common,  and  are  so 
big  as  to  present  no  difficulty.  This  is  the  only 


THE  SICK  CHILD  73 

test  whether  a  child  has  worms  or  not — to  look 
for  them.  And  their  presence  should  never  be 
neglected — the  doctor  should  be  summoned. 

THE  THROAT 

The  child's  throat  should  be  inspected 
occasionally.  This  has  the  double  advantage 
of  acquainting  the  mother  with  the  throat's 
aspect  in  health  and  of  teaching  the  child  to 
show  its  throat  without  fear. 

THERMOMETER 

Every  family  should  have  a  thermometer 
and  know  how  to  use  it.  Many  women  have 
a  superstitious  dread  of  this  useful  instrument. 
'  I  should  always  be  taking  their  tempera- 
tures and  finding  them  too  high/  they  say. 
The  true  answer  to  this  is  that  nothing  could 
be  more  worth  while.  Some  children  have 
a  tendency  to  develop  a  high  temperature 
from  a  very  slight  cause.  When  the  doctor 
is  called  in  and  finds  the  temperature  high,  it 
may  be  of  the  greatest  value  to  him  to  learn 
that  a  similar  temperature  has  often  been 
recorded  before,  and  the  child  has  been  quite 
well  again  on  the  following  day.  On  the  other 


74      THE  HEALTH  OF  THE  CHILD 

hand  it  is  a  great  comfort  when  a  child  seems 
unduly  hot  to  take  the  temperature  and 
find  that  it  is  normal.  But  if  you  use  a 
thermometer,  there  are  some  important  things 
to  remember. 

1.  Always  clean  it  thoroughly  before  returning 
it  to  its  case. — This  is  the  most  important. 
Otherwise  the  case  may  become  infected  and 
disease  may  be  conveyed  to  others. 

2.  Never  clean  it  in  hot  water. 

3.  Always  note  that  it  is  shaken  down  to  below 
'  normal '    (98.4°,  where   the   little   arrow  is) 
before  use. 

4.  Keep  it  in  for  double  the  length  of  time 
stated.     It  is  best  to  use  a  half-minute  ther- 
mometer and  keep  it  in  a  minute. 

5.  In  an  infant  take  the  temperature  in  the 
bowel,  but  remember  that  it  is  naturally  about 
a  degree  higher  here  than  in  the  groin  or  under 
the  tongue. 

6.  A  sub-normal  temperature  is  never  serious 
unless  the  child  is  obviously  very  ill. 

7.  Never  confuse  100.2°  or  100.6°  for  ex- 
ample with  102°  or  106°.     This  is  a  common 
mistake  which  leads  to  great  confusion. 


THE  SICK  CHILD  75 

RASHES 

When  a  child  develops  a  rash,  and  yet 
does  not  seem  ill,  it  is  often  a  difficult  ques- 
tion whether  it  is  necessary  to  send  for  a 
doctor.  Here  again  you  will  undoubtedly  in 
the  long  run  have  less  cause  for  regret  if  you 
sometimes  send  for  him  unnecessarily.  It  is 
by  no  means  uncommon  for  a  mild  case  of 
Scarlet  Fever  to  be  missed,  until  the  skin  peels 
or  some  late  complication  arises.  Then  again 
with  Chicken  Pox  and  German  Measles,  it  is 
quite  common  for  the  child's  general  health  to 
be  scarcely  affected,  and  yet  if  the  condition 
is  not  treated  as  an  infectious  one,  an  exti  nsive 
epidemic  may  result.  And  if  you  send  for  the 
doctor,  send  at  once,  for  the  rash  may  quickly 
change  in  appearance  or  disappear.  Re- 
member that  it  is  much  easier  to  see  the  true 
nature  of  a  rash  by  daylight  than  by  artificial 
light.  Yet  it  must  be  remembered  that  there 
are  many  other  causes  for  '  spots '  besides  the 
infectious  diseases.  The  rashes  in  infants 
associated  with  teething  and  indigestion  are 
familiar  to  most  of  us.  So  is  '  nettle-rash  ' 
produced  sometimes  by  strawberries,  shell-fish, 


76      THE  HEALTH  OF  THE  CHILD 

etc.  The  bites  of  insects  occasionally  produce 
extensive  and  puzzling  eruptions.  A  severe 
perspiration  may  be  followed  by  what  is  known 
as  a  '  sweat-rash/  And  mothers  are  often 
puzzled  by  a  rash  on  the  chest  and  back,  arising 
from  the  use  of  a  liniment  such  as  camphorated 
oil  on  a  sensitive  skin.  Generally  speaking, 
if  a  rash  is  at  the  onset  unaccompanied  by  any 
rise  of  temperature  it  is  very  unlikely  to  be  the 
sign  of  an  infectious  disease. 

COUGH  AND  CROUP 

Children  often  develop  a  slight  cold  on  the 
chest  for  which  it  does  not  seem  necessary  to 
seek  a  doctor's  advice  but  for  which  one  feels 
one  would  like  to  do  something.  One  has 
given  glycerine  and  black-currant  lozenges  and 
rubbed  the  chest  with  camphorated  oil  and 
still  this  little  cough  persists.  Do  not  have 
recourse  to  somebody's  lung  tonic  or  some- 
body else's  lightning  cough  cure.  Most 
patent  medicines  may  be  divided  into  three 
classes. 

1.  Those  whose  sole  virtue  lies  in  the  amount 
of  capital  they  can  sink  in  advertising. 

2.  Those  whose  virtue  lies  in  their  aperient 


THE  SICK  CHILD  77 

action  (and  this  is  true  of  one  very  well-known 
preparation  for  coughs). 

3.  Those  which  have  some  sedative  action 
which  allays  the  symptoms  but  does  not  cure 
the  condition. 

The  third  class  is  the  dangerous  one,  because 
it  means  that  the  disease  has  time  to  establish 
itself  before  the  doctor  is  sought  for. 

Ipecacuanha  wine  is  however  a  perfectly  safe 
household  remedy  if  used  properly.  It  may 
be  used  in  two  ways.  The  best  is  to  give  from 
two  to  six  drops,  according  to  the  child's  age, 
four  times  a  day  in  a  little  water.  If  the 
cough  is  not  better  in  a  few  days,  send  for  the 
doctor  (and  tell  him  exactly  what  has  been 
done).  The  other  way  is  to  use  it  as  an  emetic, 
giving  a  teaspoonful  every  quarter  of  an  hour 
until  the  child  is  sick.  Whilst  vomiting  it 
often  expectorates  a  quantity  of  phlegm.  This 
treatment  is  not  to  be  recommended  except  on 
the  doctor's  advice. 

Croup  is  a  name  which  has  been  used  for  a 
variety  of  conditions,  including  Diphtheria, 
catarrh  of  the  upper  part  of  the  wind-pipe 
(laryngitis)  and  a  peculiar  spasmodic  condi- 
tion of  this  part  which  occurs  in  rickety  infants 


78      THE  HEALTH  OF  THE  CHILD 

from  six  to  eighteen  months.  But  it  is  pro- 
perly used  for  an  obstruction  of  the  breathing 
which  occurs  in  children  from  2  to  6  years  of 
age.  The  child  goes  to  bed  quite  well  or  with 
perhaps  a  slight  cold  and  sometimes  between 
10  P.M.  and  2  A.M.  wakes  with  a  hard  brassy 
cough,  takes  its  breath  in  with  great  difficulty 
and  with  a  loud  crowing  noise,  is  obviously 
very  distressed,  and  may  become  blue  about 
the  cheeks  and  lips  to  an  alarming  degree. 
The  trouble  often  recurs  for  some  nights  in 
succession.  As  has  been  said,  the  appearance 
is  very  alarming  but  the  condition  is  never 
fatal.  After  one  or  two  hours,  the  attack  sub- 
sides, '  the  child  falls  asleep  exhausted  and 
wakes  next  morning  quite  well '  (Still) .  The 
immediate  treatment  is  to  moisten  the  air 
with  steam  from  a  kettle  and  to  apply  heat  to 
the  front  of  the  neck,  either  a  hot  sponge  or  a 
small  mustard  poultice. 

PAIN 

It  must  be  understood  that  when  some  part 
of  the  body  is  disordered,  the  place  where  the 
pain  is  felt  may  be  far  away  from  the  seat  of 
trouble.  Thus  in  hip  disease,  the  child  usually 


THE  SICK  CHILD  79 

says  its  knee  hurts  ;  pain  in  the  stomach  may 
be  due  to  trouble  in  the  chest  or  in  the  back- 
bone ;  ear-ache  may  be  due  to  a  bad  tooth 
and  a  teething  child  will  often  be  seen  to  pull 
its  ears.  A  point  worth  remembering  is  that 
ordinary  '  stomach-ache  '  is  relieved  by  light 
pressure  or  gentle  rubbing ;  if  the  pressure 
increases  the  pain  it  is  a  sure  sign  that  the 
doctor  should  be  sent  for. 

Warmth  always  relieves  pain  and  is  quite 
safe  treatment  while  you  are  waiting  for  the 
doctor  ;  a  hot  shawl,  a  hot-water-bottle,  a  hot 
sand  or  salt  bag,  a  poultice  or  a  hot  compress 
(see  p.  86).  These  are  the  best  means  of  reliev- 
ing pain  whether  in  the  head,  the  chest,  the 
stomach  or  the  limbs. 

CONVULSIONS 

Very  often  a  child  is  very  nervous,  starts  at 
the  least  sound  and  twitches  in  its  sleep  before 
a  convulsion  occurs.  At  this  stage  a  doctor 
can  often  prevent  the  attack ;  short  of  a 
doctor,  the  best  thing  is  a  good  dose  of  castor 
oil.  When  the  child  is  in  convulsions,  the  best 
treatment  is  to  immerse  its  body  for  a  few 
minutes  in  a  bath  of  water  that  is  distinctly 


8o      THE  HEALTH  OF  THE  CHILD 

hot,  though  quite  comfortable  to  the  elbow 
and  sponge  the  head  with  cold  water.  Then 
lay  it  in  bed,  wrapped  in  a  blanket,  and  await 
the  doctor's  arrival. 

BED-WETTING 

Never  punish  the  child  for  the  habit.  Let 
his  life  be  calm  and  free  from  excitements. 
See  that  he  does  not  suffer  from  worms 
(see  p.  72),  that  he  does  not  require  cir- 
cumcision, and  that  he  is  not  constipated. 
Encourage  him  to  drink  plenty  during  the  day, 
but  give  him  the  lightest  possible  supper  or 
none  at  all.  Wake  him  up  when  you  retire. 
It  is  a  very  troublesome  habit  which  is  sooner 
or  later  '  grown  out  of.'  Sometimes  medicinal 
treatment  is  useful. 

INFLAMMATION  OF  THE  EAR 

It  is  often  necessary  to  impress  upon 
mothers  that  '  running  ears '  constitute  a  very 
serious  complaint  and  require  medical  care. 
The  lack  of  such  treatment  often  causes 
permanent  deafness  and  may  lead  to  fatal 
complications. 


THE  SICK  CHILD  81 

THE  EYES;  BAD  HABITS;  NERVOUS 
CHILDREN 

Of  the  special  senses,  hearing,  smelling  and 
tasting  are  very  seldom  defective  from  birth  in 
children,  but  unfortunately  there  is  often  some 
defect  in  sight  which,  if  not  properly  treated, 
may  give  rise  to  a  variety  of  troubles.  A 
mother  was  once  very  much  annoyed  because 
her  child,  having  a  crooked  back,  was  sent  to  a 
hospital,  and  was  returned  with  a  pair  of  spec- 
tacles. The  trouble  with  the  back  had  come 
from  faulty  sitting  at  school  owing  to  short- 
sight.  A  child  with  a  squint  should  never  be 
left  without  expert  advice.  Headaches  are 
often  due  to  eye-strain.  So  are  red  eyelids  and 
styes.  A  habit  of  blinking  the  eyes  may  be 
due  to  the  same  cause.or  it  may  be  a  nervous 
habit. 

Bad  habits. — When  a  bad  habit  appears,  one 
should  ask  oneself — Is  it  due  to  some  quite 
extraneous  cause  such  as  mimicking  an  older 
child,  is  it  due  to  some  central  lack  of  nervous 
control,  or  is  it  due  to  some  local  trouble  which 
can  be  remedied  ?  The  local  cause  may  often 
be  removed  by,  for  example,  spectacles  for 


82      THE  HEALTH  OF  THE  CHILD 

defective  vision,  the  removal  of  adenoids  or 
appropriate  treatment  for  intestinal  worms.  If 
the  bad  habit  be  due  to  central  lack  of  nervous 
control,  the  treatment  lies  rather  in  the  exercise 
of  more  than  usually  strict  discipline  coupled 
with  more  than  usual  care  to  avoid  punish- 
ments— rewards  for  improvement  are  much 
more  efficacious.  By  discipline  is  meant  en- 
couraging the  child  in  all  its  daily  occupations 
to  practise  self-control,  always,  for  instance,  to 
finish  what  it  begins  doing,  and  never  to  try  to 
do  two  things  at  once. 

A  '  nervous  child  '  should  have  a  life  not 
deficient  in  interest  but  on  the  other  hand  not 
too  exciting.  It  should  mix  freely  with  other 
children  but  should  avoid  parties.  Every- 
thing should  be  done  in  the  way  of  plain  whole- 
some food  and  out-of-door  life  and  early  bed- 
time to  improve  the  bodily  health.  Although 
discipline  is  more  than  usually  important  it 
should  not  be  too  Spartan.  Most  children, 
properly  trained,  have  no  fear  of  sleeping  in 
the  dark.  But  to  some  of  them  the  dark  is 
full  of  terrors,  and  such  should  be  provided 
with  a  night-light. 

Children  can  suffer  horribly  in  the  hands  of 


THE  SICK  CHILD  83 

unimaginative  adults.  I  know  a  lady  who 
recalls  with  loathing  the  agony  that  she  en- 
dured as  a  little  girl  from  being  made  to  wear 
flannel  next  her  skin.  No  complaint  of  a  child 
should  lightly  be  dismissed  as  a  fad,  until  one 
has  assured  oneself  that  it  does  not  carry  with 
it  other  unpleasant  association  in  the  child's 
mind  and  that  it  is  not  the  expression  of  some 
quite  genuine  idiosyncrasy. 

HOME  NURSING 

It  is  very  difficult  to  persuade  mothers  of 
the  importance  of  keeping  the  child  in  bed 
wher  it  is  out  of  sorts.  Often  the  difficulty  is 
that  the  mother  cannot  be  in  the  kitchen  and 
bedroom  at  the  same  time.  Usually  the  bed 
can  be  put  in  a  cool  corner  of  the  kitchen. 
Constant  dandling  in  the  mother's  arms  is 
wearying  to  the  child,  and  though  the  mother 
has  the  satisfaction  of  feeling  that  she  is  doing 
something,  she  also  gets  needlessly  exhausted. 
Kept  in  bed,  the  child  may  have  a  good  cry 
at  first,  but  will  then  settle  down.  The  great 
advantage  is  that  it  is  then  in  a  position  to 
drop  off  to  sleep  at  any  moment,  and  may 


84      THE  HEALTH  OF  THE  CHILD 

then  remain  asleep  for  a  long  time  to  its  great 
benefit. 

Some  brief  hints  for  nursing  in  the  sick-room 
may  be  useful. 

Quiet  is  important — quiet  shoes  and  quiet 
manners,  and  especially  the  avoidance  of 
sudden  noises.  The  coals  are  not  shovelled 
on,  but  handled  with  the  help  of  an  old  glove 
and  the  doors  are  not  banged.  On  the  other 
hand,  whispering  and  tip-toe  walking  are  ex- 
tremely trying  to  the  patient. 

Health  of  the  Nurse. — In  the  case  of  a  long 
illness,  it  is  bad  policy  for  a  mother  to  martyr 
herself  for  the  sake  of  the  child.  Good  health 
is  essential  to  good  nursing.  Daily  outdoor 
exercise,  a  daily  uninterrupted  and  adequate 
spell  of  rest,  and  proper  regular  meals  are 
essential. 

COMMON-SENSE  RULES 

Measure  quantities  rather  than  guess  at  them, 
e.g.  sleep. 

Tell  the  doctor  everything.  The  most  import- 
ant thing  is  apt  to  come  last. 

Aim  at  precision. — Mothers  are  wont  to  say 


THE  SICK  CHILD  85 

that  a  child  has  had  some  symptom  for  '  some 
time/ 

Keep  anything  strange  vomited  or  passed. 

Don't  fuss. — Remember  that  both  you  and 
the  doctor  are  only  fallible  and  that  you  can 
both  only  do  your  best. 

Don't  try  treatments  of  your  own  (usually  your 
friends')  simultaneously  with  the  doctor's 
treatment. 

Food. — Nagging  will  never  make  a  child  who 
is  ill  eat  more,  but  it  makes  a  great  difference 
whether  the  food  is  presented  in  a  palatable 
form  or  not.  Every  mother  should  know  some- 
thing of  cooking  if  only  to  help  her  to  detect 
what  is  wrong  in  the  discarded  dish.  Invalid 
food  often  requires  special  care.  Benger's 
Food  is  an  obvious  example,  and  peptonized 
milk  is  horrid  if  it  is  not  properly  prepared. 

It  is  well  to  remember  that  in  the  case  of 
fever  no  meat  extract — such  as  is  found  in 
stock  soup,  beef  tea  and  Bovril — should  be 
given.  These  should  be  reserved  for  the  con- 
valescent period  succeeding  the  fever.  The 
importance  of  always  giving  a  child  as  much 
water  as  it  will  drink  has  already  been  dealt 
with  (p.  44). 


86      THE  HEALTH  OF  THE  CHILD 

A  fire  in  a  sickroom  is  nearly  always  worth 
while.  It  is  cheerful,  it  helps  to  keep  the  air 
moving,  and  it  is  useful  for  burning  odd  bits 
and  warming  things. 

The  Bed.  Never  have  the  child's  bed  facing 
the  window. — It  usually  does.  The  child  gets 
a  headache  from  having  the  light  in  its  eyes  all 
day,  and  in  the  case  of  an  older  child,  the 
printed  page  of  its  book  is  in  the  dark.  The 
bed  should  be  placed  sideways,  so  that  the 
child  can  see  out  if  it  wishes.  To  have  nothing 
but  a  wall  to  stare  at  all  day  is  trying. 

The  mattress  of  every  child's  bed,  well  or 
ill,  should  be  rather  hard.  A  feverish  child 
often  has  more  instead  of  fewer  bed-clothes  on 
it.  It  must  be  completely  but  quite  lightly 
covered.  It  is  scarcely  ever  dangerous  for  a 
small  child  whatever  its  illness  to  sit  up  if  it 
wants  to,  provided  that  it  is  properly  covered. 

THINGS  THE  DOCTOR  WILL  WANT  TO  KNOW 

What  is  the  favourite  attitude  of  the  child  ? 
Are  these  flushes,  twitchings,  perspiration  ? 

Pain. — In  the  case  of  an  infant  does  it  put 
its  hand  to  any  part  as  though  in  pain  or  pull 
its  legs  up  ?  In  the  case  of  an  older  child  is 


THE  SICK  CHILD  87 

the  pain  constant  or  intermittent  ?  Relieved 
or  increased  by  pressure  ?  Fixed  at  one  spot 
or  shooting  in  some  direction  ? 

The  tongue. — Has  it  been  furred  or  clean  ; 
dry  or  moist  ? 

The  cry. — Is  it  loud,  which  means  that  the 
child  is  strong  and  has  clear  lungs  ?  Is  it 
constant,  which  always  means  that  the  child  is 
in  pain  ? 

Sickness. — Is  this  only  nausea  or  does  the 
child  actually  vomit  ?  If  so,  what  does  it 
bring  up.  How  has  the  appetite  been  ? 

The  urine. — Its  colour,  quantity,  consistency. 
A  feverish  child  nearly  always  passes  urine 
which,  on  standing,  has  a  thick  reddish  deposit. 
This  often  causes  unnecessary  alarm. 

These  are  but  samples ;  everything  out  of 
the  normal  should  be  reported. 

THINGS  THE  DOCTOR  MAY  ORDER 

Fomentations  (Hot  Compresses).  —  Fold  a 
piece  of  flannel  to  make  a  pad  of  four 
layers.  Place  it  in  a  hand  towel,  lightly  twist 
the  ends  of  the  towel  and  place  in  a  basin  with 
the  ends  of  the  towel  hanging  out.  Pour  on 
boiling  water.  Twist  the  towels  tightly  to 


88      THE  HEALTH  OF  THE  CHILD 

squeeze  out  as  much  water  as  is  possible. 
Apply  the  flannel  pad  and  cover  with  a  piece  of 
waterproof  such  as  oil-silk  or  jackinet. 
The  important  points  are  : 

1.  The  water  should  be  actually  boiling. 

2.  The  better  it  is  squeezed,  the  hotter  it  can 
be  applied. 

3.  The  waterproof  should  overlap  the  edge 
of  the  flannel  all  round. 

4.  The  waterproof  should  be  placed  handily, 
so  that  it  can  be  clapped  over  the  instant  the 
flannel  is  applied. 

5.  The  patient  should  not  be  burnt.     It  is 
a  good  plan  to  put  your  hand  between  the  skin 
of  the  patient  and  the  flannel  at  the  moment 
of  application,  and  gradually  withdraw  it. 

Instead  of  water,  an  antiseptic  solution  may 
be  used.  Fomentations  are  more  handy  and 
cleaner  than  poultices  but  do  not  keep  the  heat 
so  long. 

Poultices. — The  most  useful  are  linseed, 
mustard  and  bread. 

The  linseed  poultice. — A  little  practice  is 
worth  a  great  deal  of  description.  The  chief 
thing  to  remember  is  that  everything  should 
be  very  hot.  The  linseed  may  be  stirred 


THE  SICK  CHILD  89 

into  the  boiling  water,  or  the  water  poured 
into  the  linseed.  The  mixture  is  stirred 
with  a  spoon,  previously  heated,  until  it  is 
semi-solid.  It  is  then  spread  on  a  square  of 
old  linen,  to  form  a  layer  a  quarter  of  an  inch 
to  half  an  inch  thick,  the  edges  of  the  linen  are 
turned  over  and  the  linseed  is  applied  direct 
to  the  skin  with  nothing  intervening. 

The  mustard  poultice  is  made  the  same  way, 
except  that  about  one  part  of  mustard  is  added 
to  four  parts  of  linseed. 

The  bread  poultice  is  made  by  stirring  the 
crumbs  of  stale  bread  into  boiling  water,  and 
keeping  the  whole  hot  for  five  minutes  to  allow 
the  bread  to  swell. 

Poultices  should  never  be  applied  to  an  open 
sore,  such  as  a  discharging  whitlow,  because, 
from  the  surgical  form  of  view,  they  are 
dirty. 

Boracic  Acid  lotion. — A  heaped  teaspoonful 
of  Boracic  Acid  crystals  may  be  dissolved  in  a 
breakfast  cup  of  warm  water.  Another  useful 
plan  is  to  keep  a  large  bottle  of  '  saturated ' 
solution  (i.e.  water  to  which  Boracic  Acid 
has  been  added  until  some  remains  undis- 
solved)  and  when  lotion  is  required,  to  mix 


90      THE  HEALTH  OF  THE  CHILD 

some  of  this  with  an  equal  quantity  of  hot 
water. 

Albumen  Water. — Take  the  white  of  one 
fresh  egg,  divide  it  in  several  directions  with  a 
pair  of  clean  scissors,  then  mix  it  with  eight 
ounces  of  cold  water  in  a  bottle,  and  shake 
vigorously  ;  strain  through  muslin. 

Beef  Juice. — One  pound  of  finely  chopped 
rump  steak,  six  ounces  of  cold  water,  a  pinch 
of  salt ;  place  in  a  covered  jar  and  stand  six 
hours.  Strain  and  squeeze  the  juice  out  by 
putting  the  meat  in  coarse  muslin  and  twisting 
it  very  hard.  Warm  by  placing  the  cup  in  hot 
water. 

Beef -Tea. — One  pound  of  finely  chopped  lean 
beef,  one  pint  of  cold  water,  a  pinch  of  salt. 
Cook  for  three  hours  over  a  slow  fire  down  to 
half  a  pint,  adding  water  if  necessary.  Strain 
through  muslin  and  when  cold  carefully  re- 
move the  fat. 

There  are  various  ways  of  making  beef-tea. 
The  method  described  gives  a  product  which 
is  more  stimulating  than  nourishing.  If  flakes 
of  beef  are  left  in,  the  result,  though  not  so 
easy  to  digest,  is  much  more  of  a  food. 

Whey. — One  pint  of  milk  warmed  ;   a  pinch 


THE  SICK  CHILD  91 

of  salt ;  a  teaspoonful  of  sugar.  Add  two 
teaspoonfuls  of  liquid  rennet,  stir,  and  allow 
to  stand  for  twenty  minutes.  Break  up  the 
curd  and  strain  through  muslin. 

Things  to  have  in  the  Medicine  Chest. — A  few 
roller  Bandages,  Cotton  wool,  boracic  Lint, 
Boracic  Acid  crystals,  some  antiseptic  such 
as  Cyllin,  Castor  oil,  Ipecacuanha  wine,  Cam- 
phorated oil,  Glycerine,  '  New  Skin/  a  reel  of 
Zinc-oxide  Strapping,  £  inch  width,  Carron  oil 
with  10  per  cent.  Eucalyptus  oil  (v.  Burns), 
Oiled  silk,  boracic  Vaseline,  a  Glycerine  Syringe. 

MEASURES 

2  Teaspoonfuls=a  Dessertspoonful, 

2  Dessertspoonfuls=a  Tablespoonful, 

2  Tablespoonfuls=an  Ounce. 

20  Ounces=a  Pint. 

It  is  often  said  that  a  teaspoonful  equals  a 
drachm,  but  in  point  of  fact  the  ordinary  tea- 
spoon holds  nearly  two  drachms.  A  tumbler 
holds  just  under  half  a  pint. 

COMMON  INFECTIOUS  DISEASES  OF  CHILDHOOD 

An  infectious  disease  is  one  that  spreads 
from  one  person  to  another.  All  infectious 


92      THE  HEALTH  OF  THE  CHILD 

diseases  are  probably  caused  by  some  microbe 
(or  germ).  The  infectious  diseases  common  in 
childhood  are  Measles,  German  Measles,  Scarlet 
Fever,  Chicken  Pox,  Whooping  Cough,  Mumps 
and  Diphtheria.  It  is  an  unfortunate  thing  that 
so  far  in  the  case  of  none  of  these  diseases 
except  the  last  mentioned  (Diphtheria)  has  the 
offending  microbe  been  found.  A  very  infec- 
tious disease,  common  to  all  ages,  is  the  ordinary 
cold  in  the  head.  There  is  a  considerable 
amount  of  evidence  to  show  that  a  cold  in  the 
head  is  never  contracted  except  by  infection 
from  another  person.  Therefore  any  one  who 
has  a  cold  should  be  most  careful  to  hold  a 
handkerchief  to  his  face  when  he  coughs  or 
sneezes,  to  keep  his  room  thoroughly  ventilated 
and  to  avoid  kissing  others.  In  fact  it  should  be 
a  universal  rule  never  to  kiss  any  one  outside 
your  own  family.  Some  infectious  diseases  pro- 
duce what  is  called  immunity.  That  means 
that  having  once  passed  through  an  attack 
one  is  not  likely  to  get  the  complaint  again. 
The  amount  of  immunity  varies  with  different 
diseases  but  of  no  disease  can  it  be  said  to  be 
impossible  to  have  a  second  attack.  Other 
infectious  diseases  like  a  cold  or  influenza 


THE  SICK  CHILD  93 

produce  no  immunity  whatever  or  one  that 
passes  off  very  quickly. 

After  a  child  has  been  exposed  to  infection, 
some  time  passes  before  he  shows  any  sign  of 
being  ill  ;  this  is  called  the  period  of  incubation. 
This  varies  in  duration,  and  while  it  lasts  he 
must  be  kept  away  from  other  children.  So  that 
we  have  the  average  period  of  incubation  which 
gives  the  date  at  which  he  is  likely  to  become 
ill  and  the  longest  possible  period  of  incubation 
which  gives  the  date  at  which,  if  he  is  still 
quite  well,  he  may  be  considered  safe. 


Quarantine  Period. 

Chicken  Pox  14  days  21  days 
Measles                          „  „ 

German  Measles  ,,  „ 

Whooping  Cough          ,,  „ 

Scarlet  Fever  2-7  days  14  days 

Diphtheria  very  variable  ,, 

Mumps  2-3  weeks  24  days. 

The  onset  of  these  diseases  will  now  be 
described  very  briefly  ;  in  every  doubtful  case 
it  is  safer  to  consult  a  doctor. 

Measles.  —  For  a  few  days,  the  child  seems 


94      THE  HEALTH  OF  THE  CHILD 

out  of  sorts ;  he  has  a  little  cough,  sneezes 
occasionally  and  complains  that  his  eyes  hurt 
him.  After  three  or  four  days  he  becomes 
distinctly  feverish  and  spots,  the  size  of  a  pea, 
appear  all  over  him,  including  the  face. 

German  Measles  is  quite  a  separate  disease, 
though  very  similar.  There  are  generally  few 
obvious  signs  except  the  rash  and  a  slight  rise 
of  temperature  at  the  onset. 

Scarlet  Fever. — The  onset  is  very  sudden  with 
a  high  temperature,  sore  throat  and  headache. 
Often  the  child  vomits.  The  rash  consists  of 
spots,  smaller  than  pin's  head  and  so  close  that 
often  the  appearance  is  that  of  a  red  blush 
over  the  chest.  It  usually  appears  within 
twenty-four  hours  of  the  onset  of  the  disease. 
Although  the  cheeks  are  flushed,  there  is  no 
rash  on  the  face. 

Chicken  Pox. — The  child  is  seldom  very  ill. 
Often  the  rash  first  calls  attention  to  the 
condition.  The  spots  are  scattered  all  over  the 
body,  the  scalp  and  the  palate.  Some  are 
little  pimples  and  others  are  blisters  like  drops 
of  water  on  the  skin. 

Diphtheria. — The  temperature  is  seldom  very 
high,  although  often  the  child  looks  very  ill. 


THE  SICK  CHILD  95 

The  glands  of  the  neck,  on  one  side  or  both 
are  swollen  and  there  is  a  white  patch  on  one 
or  both  tonsils.  Little  white  pin-points  on 
the  tonsils  usually  mean  simple  tonsillitis  (not 
Diphtheria).  The  early  use  of  antitoxin  is  so 
important  that  not  an  hour  should  be  lost,  in 
the  case  of  a  suspect,  in  applying  to  the  doctor. 

Whooping  Cough. — There  is  an  ordinary 
cough  for  a  week  or  ten  days.  Then  the 
intervals  between  the  attacks  of  coughing 
become  longer  and  each  attack  consists  of  a 
series  of  little  coughs  ending  by  a  long,  noisy 
in-drawing  of  the  breath  which  constitutes  the 
whoop.  The  cough  is  often  so  severe  that  the 
child  dreads  the  approach  of  each  paroxysm, 
the  face  becomes  congested  and  the  food  may 
be  vomited.  Very  often  the  cough  is  worse  at 
night.  This  is  the  only  disease  in  which  a 
child  spits  out  the  phlegm. 

Mumps. — Mumps  is  often  difficult  to  distin- 
guish from  enlarged  glands  of  the  neck,  but  the 
swelling,  in  the  former,  spreads  over  the  angle 
of  the  jaws  on  to  the  face  in  front  of  the  ear. 
With  enlarged  glands,  the  swelling  is  strictly 
confined  to  the  neck.  With  Mumps  there  is 
usually  discomfort  on  opening  the  mouth. 


96      THE  HEALTH  OF  THE  CHILD 

No  child  should  ever  be  exposed  to  infection 
if  it  can  be  avoided.  It  is  often  tempting, 
with  a  large  family,  to  aim  at  their  all  getting 
over  it  at  once,  but  it  has  to  be  remembered 
that  the  mildest  disease  occasionally  assumes  a 
very  grave  form. 

One  word  as  to  the  mortality  of  Measles  and 
Whooping  Cough.  A  great  many  children  die 
from  these  diseases  and  most  of  these  deaths 
could  have  been  prevented.  Insufficient  care 
while  the  child  is  convalescing  leads  to  '  a 
chill '  and  some  serious  complication  ensues. 
Amongst  the  uneducated  some  acquaintance 
with  these  risks  would  prevent  many  tragedies. 

EMERGENCIES 
FOREIGN  BODIES 

1.  Swallowed. — Never  give  the  child  opening 
medicine.     Give  gruel,  porridge  or  bread  and 
milk,  and  strain  the  stools  through  muslin  until 
the  object  is  recovered. 

2.  In  the  ear. — If  there  is  the  least  difficulty, 
leave  it  alone  until  you  get  a  doctor. 

3.  In  the  nose. — Get  the  child  to  blow  with 


THE  SICK  CHILD  97 

the  other  nostril  closed.     Or  syringe  up  the 
clear  nostril. 

4.  In  the  throat. — If  the  child  is  choking,  try 
to  remove  the  object  with  your  fingers.     If  you 
can't,  hold  the  child  up  by  the  feet,  head 
downwards. 

5.  In  the  eye. — If  you  cannot  get  it  out  with 
a  clean  handkerchief  or  by  lifting  the  upper  lid 
over  the  lower,  bathe  with  warm  boracic  lotion 
squeezed  out  of  a  piece  of  clean  cotton  wool.     If 
this  fails,  send  for  the  doctor. 

Burns. — The  best  applications  to  keep  in  the 
house  for  burns  are  (i)  a  i  per  cent,  solution  of 
Picric  Acid,  (2)  Carron  oil  with  10  per  cent. 
Eucalyptus  Oil  added.  For  quite  slight  burns, 
flour  or  salad  oil  are  of  use. 

The  danger  of  a  bad  burn  is  proportional 
to  the  extent  of  surface  involved,  not  to  the 
depth.  It  is  worse  on  the  trunk  than  on 
the  limbs.  Death  is  either  immediate,  due 
to  shock  or,  later  on,  due  to  blood  poison- 
ing. Therefore  with  a  bad  burn  the  great 
thing,  as  in  so  many  emergencies,  is  not  what 
to  do  but  what  not  to  do.  Do  not  attempt 
to  remove  the  clothes  and  do  not  put  on 
any  grease  unless  it  is  antiseptic.  Keep  the 


98      THE  HEALTH  OF  THE  CHILD 

child  very  warm  and  quiet  until  the  doctor 
comes. 

Wounds. — Bleeding  from  a  wound  usually 
looks  worse  than  it  is.  The  great  things  to 
remember  are  to  apply  pressure  directly  on 
the  bleeding  spot,  to  keep  the  patient  lying 
down,  and  if  the  wound  is  on  the  arm  or  leg, 
to  raise  the  limb.  For  further  details  you 
must  consult  a  book  on  First  Aid. 

An  antiseptic  such  as  Lysoform  or  Jeye's 
Fluid  should  always  be  kept  in  the  house.  A 
wound  should  be  thoroughly  washed  with  a 
lather  of  soap  and  water,  and  then  a  piece  of 
clean  lint  which  has  been  dipped  in  the  anti- 
septic (a  tea-spoonful  to  the  pint  of  hot  water) 
should  be  bound  over  it. 

Dog  bites  are  in  England  no  more  dangerous 
than  any  other  wound  which  may  be  dirty, 
and  should  be  treated  in  the  same  way. 

Hydrophobia  is  stamped  out  in  England. 

Nose-Bleeding. — The  child  should  lie  flat 
on  its  back  with  its  head  turned  to  one  side, 
and  it  should  be  provided  with  a  soap-dish  into 
which  to  spit  the  blood  as  it  collects  in  the 
throat.  If  it  keeps  quite  still,  the  bleeding 
will  nearly  always  soon  stop. 


THE  SICK  CHILD  99 

Bruises. — Very  little  can  or  need  be  done. 
Lead  lotion  is  a  soothing  application,  or  the 
treatment  adopted  in  the  case  of  Jack  and  Jill 
may  be  followed. 

Concussion. — A  child's  head  is  very  elastic 
and  can  sustain  with  impunity  many  a  nasty 
blow.  But  if  a  child  after  a  fall  on  the  head 
appears  drowsy  and  vomits,  it  is  better  to 
consult  a  doctor. 

Fractures  and  Dislocations. — In  a  suspected 
case,  do  nothing  but  support  the  limb  until  the 
arrival  of  the  doctor. 

Poisons. — If  a  child  has  swallowed  something 
poisonous  it  must  be  made  to  vomit  either  by 
piitting  a  finger  down  its  throat  or  by  giving  it 
an  emetic.  The  best  emetic  is  Ipecacuanha 
wine,  a  teaspoonful  in  a  little  water,  every  ten 
minutes,  until  vomiting  occurs.  Usually  two 
doses  will  prove  sufficient. 

An  emetic  should  not  be  given  if 

i.  A  caustic  poison  has  been  swallowed. 
There  will  be  sore  congested  patches  about  the 
lips  and  mouth  and  great  pain  in  the  chest  and 
stomach.  If  the  poison  is  known  to  be  an  acid, 
give  Baking  Soda  in  water;  if  it  is  an  alkali  (such 
as  caustic  soda)  give  weak  vinegar  or  lemon  juice. 


ioo    THE  HEALTH  OF  THE  CHILD 

2.  The  child  has  already  vomited  effectually. 

3.  The  child  is  extremely  collapsed. 

4.  The  length  of  time  that  has  elapsed  makes 
it  certain  that  none  of  the  poison  remains  in 
the  stomach. 

It  is  always  safe  (except  in  the  rare  case  of 
Phosphorus  poisoning)  to  give  milk  and  raw 
eggs  beaten  up. 

In  any  case  of  severe  collapse,  it  is  important 
to  keep  the  child  quiet,  lying  down  flat  and 
warm. 


VI 

TRAINING  THE  CHILD 

IN  the  training  of  a  child,  the  character  with 
which  he  is  born  and  the  characters  of 
those  who  care  for  him  are  the  things  that 
count.  As  far  as  the  child  is  concerned,  the 
stuff  that  is  in  him  is  much  more  important 
than  the  method  used  for  bringing  it  out.  For 
systems  of  Education  come  and  go.  Each  one, 
as  it  comes  to  hold  the  field,  occasions  some 
searching  of  soul  amongst  those  who  have  been 
using  other  systems,  until  it  in  turn  gives  way 
to  something  yet  more  up-to-date.  And  to  all 
of  them  there  is  one  thing  in  common.  Their 
success  has  depended  far  more  on  the  person- 
alities of  their  founders  than  on  any  intrinsic 
features  of  the  method.  This  is  not  to  say 
that  one's  method  of  training  is  without  im- 
portance ;  but  it  is  a  source  of  some  consolation 
to  an  anxious  parent  perplexed  by  many  rival 

claims.     It  encourages  one  to  keep  an  open 

101 


102    THE  HEALTH  OF  THE  CHILD 

mind.  Our  ideas  of  education  are  still  ex- 
tremely inchoate.  The  words  of  Stevenson 
have  their  application.  '  We  must  not  be 
pontiffs  holding  doctrines  but  huntsmen  quest- 
ing after  elements  of  truth.' 

Only  second  in  importance  to  the  personality 
of  the  child  is  the  personality  of  its  guardian. 
From  which  it  follows  that  parents  must  try 
to  be  worthy  of  their  children.  A  child  cannot 
choose  its  parents  ;  but  parents  can  choose  to 
alter  their  way  of  living  for  the  sake  of  their 
children.  The  Japanese  have  put  something 
of  the  force  of  religion  into  their  reverence  for 
their  ancestors,  with  great  resulting  benefit  to 
their  race.  But  there  is  something  yet  nobler 
in  the  ideal  which  consecrates  one's  life  not 
to  those  who  have  gone  but  to  those  who  are 
yet  to  come. 

It  is  obvious  that  the  parents  must  be  pre- 
pared to  devote  time  to  their  children.  Especi- 
ally is  this  true  of  the  mother.  However 
admirable  her  personality,  it  is  of  little  avail, 
if  a  nurse  acts  as  a  complete  barrier  between 
her  and  the  child.  A  nurse  is  often  a  necessity; 
but  it  is  always  a  regrettable  necessity. 
Nothing  is  more  valuable  to  a  child  than 


TRAINING  THE  CHILD  103 

that  familiarity  with  its  mother  which  is  only 
begotten  of  constant  companionship  and  which 
makes  him  realise  that  in  her  he  has  a  refuge 
in  all  his  trials  and  troubles. 

Invaluable  as  this  knowledge  is  from  in- 
fancy to  adolescence,  yet  from  infancy  too 
a  child  must  learn  that  his  mother  cannot  be 
always  with  him.  Training  begins  from  the 
first  week  of  life.  Nothing  is  more  remarkable 
than  the  facility  with  which  an  infant  acquires 
habits.  It  learns  from  the  first  week  to  require 
its  food  at  regular  intervals,  to  go  to  sleep  when 
replaced  in  its  cot  and  to  'do  its  duty  when  it  is 
'  held  out/  If  it  cries  when  the  mother  leaves 
it,  it  must  be  allowed  to  cry.  The  ideal  usually 
held  out  to  the  young  mother  is  to  let  it  cry 
until  it  stops.  This  is  an  excellent  ideal ;  a 
healthy  child,  crying  only  from  vexation,  may 
get  very  exhausted,  but  it  never  does  itself 
any  serious  harm.  In  practice,  it  is  a  very 
difficult  ideal  to  live  up  to  ;  one  can  only 
do  one's  best. 

This  naturally  leads  us  to  the  difficult 
question  of  punishments,  a  question  on  which 
it  behoves  all  of  us  to  speak  with  great  diffi- 
dence. If  kindness  is  tempered  by  firmness, 


104    THE  HEALTH  OF  THE  CHILD 

punishment  is  reduced  to  a  minimum.  Never- 
theless it  has  its  proper  place.  The  first  thing 
to  remember  here,  as  always,  is  that  no  two 
children  can  be  treated  alike. 

With  regard  to  corporal  .punishment  especi- 
ally, there  are  as  many  opinions  as  there  are 
teachers.  I  can  only  state  my  own.  Between 
the  ages  of  two  and  four  years,  a  child  is  old 
enough  to  connect  the  punishment  with  the 
offence,  but  is  not  old  enough  to  be  amenable 
i-)  argument.  During  this  period,  a  smacking 
applied  very  rarely  and  with  great  ceremony 
'  carefully  and  prayerfully '  is,  for  some 
children,  entirely  beneficial.  Later  on,  when 
a  child  defies  authority,  some  deprivation  or  a 
short  spell  of  meditation  in  bed  is  all  that  is 
required.  Smacking,  it  must  be  repeated, 
should  be  sufficiently  rare  to  be  an  event,  it 
should  be  applied  with  great  deliberation,  and 
above  all  things,  a  child  should  never  be 
casually  hit  on  the  head. 

In  reality,  if  a  mother  is  only  consistent  and 
always  means  what  she  says,  the  habit  of 
obedience  is  readily  acquired.  And  if  it  is  not, 
what  is  the  alternative  ?  The  child  is  spoilt. 
It  is  astonishing  that  this  profoundly  significant 


TRAINING  THE  CHILD  105 

phrase — spoiling  a  child — is  used  so  casually. 
Few  of  us  wilfully  spoil  our  best  valued  pos- 
sessions. But  a  good  many  people  quite  wil- 
fully spoil  the  human  beings  whom  they  have 
brought  into  the  world.  If  one  pauses  to 
think  one  cannot  but  realise  its  gravity. 
Direct  cruelty  to  a  child  is  abhorrent  to  us  all. 
Yet  the  cruelty  of  spoiling  a  child,  though 
indirect,  is  none  the  less  real.  There  is  an 
impression  that  a  spoilt  child  improves  as  it 
grows  older.  This  is  true  and  it  is  equally  true 
that  a  child  that  has  been  treated  with  direct 
cruelty  will  often  seem  to  throw  off  the  effects 
later.  But  nothing  can  undo  the  evil.  And  it 
is  abundantly  evident  to  the  observant  that 
the  spoiling  of  a  child  can  never  be  undone — 
that  something  of  the  fineness  of  its  character 
is  gone  permanently. 

Spoiling  is  often  due  to  excessive  anxiety, 
which  leads  to  coddling  the  child.  Ruskin, 
in  Praterita,  regrets  that  '  his  character  was 
innocent  by  protection,  not  virtuous  by 
practice/  The  burnt  child  minds  the  fire ; 
that  is  what  Ruskin  means  by  being  virtuous 
by  practice.  But  one  can  go  too  far  in  the 
hardening  process  and  incur  unwarranted  risks. 


ro6    THE  HEALTH  OF  THE  CHILD 

One  must  bear  in  mind  that  the  child  may  be 
dangerously  burnt.  One  sees,  for  instance, 
children  whose  parents  are  eager  to  harden 
them,  insufficiently  clothed,  unsuitably  fed 
and  allowed  to  forgather  with  unsuitable 
companions.  But  one  sees  far  oftener  the 
child  who  is  so  over-clothed  that  it  does  not 
care  to  run  and  climb,  so  pestered  about  its  food 
that  the  relish  of  it  has  gone,  and  so  hedged 
about,  that  it  has  no  companions  at  all,  desir- 
able or  otherwise. 

The  young  child  should  have  all  the  freedom 
it  can  get ;  freedom  to  roam,  freedom  to  dream 
and  freedom  to  get  into  a  mess.  Only  too 
soon  comes  the  drudgery  of  school  and  all  the 
machinery  for  producing  an  efficient  citizen. 
It  is  impossible  to  lay  down  rules  as  to  when 
lessons  should  begin.  John  Stuart  Mill  studied 
the  classics  in  his  infancy  and  apparently 
throve  on  it ;  but  for  most  children  one  is  safe 
to  say  that  while  they  are  happy  all  day, 
running  wild  and  playing,  there  is  no  hurry  to 
begin  lessons.  It  is  when  time  hangs  heavy 
on  the  child's  hands  that  the  value  of  a  short 
daily  lesson  becomes  apparent.  And  it  will 
be  found  that '  the  only  child  '  suffers  less  from 


TRAINING  THE  CHILD  107 

its  unfortunate  situation  if  it  is  sent  early 
to  school.  As  the  child  grows  older,  school 
demands  more  and  more  of  it.  These  demands 
are  legitimate.  But  it  must  never  be  forgotten 
that  the  healthy  mind  demands  a  healthy 
body. 


INDEX 


ADENOIDS,  10,  66-70. 
Air,  fresh,  62. 
Albumin  water,  49,  90. 
Allen  bury  bottles,  24. 
Anaemia,  10,  59. 
Ante-natal  conditions,  3,  14,  16. 
Antiseptics,  89,  91,  98. 
Aperients,  15,  46,  47,  48. 
Apples,  39,  40. 
Auto-massage,  55,  59. 
Aymard's  sterilizer,  30. 

BACON  fat,  43. 
Bananas,  40. 
Barley  water,  29. 
Bathing,  52,  53. 
Beds,  86. 

Bed  wetting,  44,  80. 
Beef  dripping,  43. 

juice,  90. 

tea,  90. 

Belts,  54. 
Bent  legs,  59. 
Bicycles,  60. 
Binders,  5,  54. 
Biscuits,  43. 
Bites,  of  dogs,  98. 

of  insects,  76. 

Bleeding,  98. 

Body  temperature,  3. 

Boiled  milk,  30. 

Bolting  food,  44. 

Bones,  development  of,  10,  59. 

Boracic  acid  lotion,  89. 

Bottles,  24. 

Bowels,  regularity  of,  45-48. 


Boy  scouts,  60. 
Breast-feeding,  17-24. 
Breathing  exercises,  69,  70. 
Bronchial  catarrh,  68. 
Bronchitis  and  teething,  9. 
Bruises,  99. 
Burns,  97. 
Butter,  43. 

CALOMEL,  47. 
Caries  of  teeth,  9-13. 
Casein,  18. 
Castor  oil,  46,  47. 
Catarrh  of  the  nose,  64. 
Cereal  foods,  38. 
Chicken  pox,  94. 
Chills,  64,  66,  96. 
Chocolate,  12. 
Choking,  97. 
Circumcision,  80. 
Cleanliness,  i,  n,  19,  24,  51. 
Clothing,  54-56. 
Cold  catching,  64. 

baths,  53. 

meat,  44. 

Colic,  41,  45. 
Comforters,"  68. 
Concussion,  99. 
Constipation,  45-48. 
Convulsions,  79. 
Cough,  76. 
Cow's  milk,  19. 
Cream,  29,  34. 
Croup,  77. 
Crying,  21,  87. 
Curd  indigestion,  28. 

109 


no  THE  HEALTH  OF  THE  CHILD 


DECAYED  teeth,  9. 
Diarrhoea,  48-50. 
Diets,  ii,  37-45. 
Dinneford's  magnesia,  46. 
Diphtheria,  94. 
Dirty  milk,  24,  30. 
Dislocations,  99. 

EAR  trouble,  80,  96. 
Emetics,  77. 
Enemas,  47. 
Exercise,  58-60. 
Eyes,  defective,  81. 
—  foreign  body  in,  96. 

FAT,  43. 

Faults  of  hand  feeding,  30-34. 

Feeding  bottles,  24. 

Fever,  73,  85,  87. 

Fire  guards,  57. 

Fires,  57,  86. 

Flatulence,  33,  45. 

Flies,  49. 

Fomentations,  87. 

Foot  gear.  56. 

Fractures,  99. 

Fresh  air,  62,  63. 

Furniture,  57. 

GAS  stoves,  57. 
German  measles,  94. 
Glands,  9,  68,  95. 
Goat's  milk,  18. 

HABITS,  81. 

Hand-feeding,  19-22,  24-34. 
Headache,  10. 
Hip  disease,  78. 
Home-nursing,  83-91. 

INCUBATION  period,  93. 
Indigestion,  10-28. 
Infectious  diseases,  91. 
Invalid  feeding,  85,  90. 
Ipecacuanha,  77,  99. 

LACT-ALBUMIN,  iS. 


Laryngitis,  77. 
Lime  water,  29. 
Liquorice  powder,  48. 
'  Little  folks  '  bottles,  24. 
Lymph,  58. 

MAGNESIA,  46. 

Malted  rusks,  37. 

Manna,  46. 

Maternal  impressions,  16. 

Measles,  93. 
j  Measures,  91. 
j  Medicine  chest,  91. 

Menstruation,  8,  22. 

Microbes,  i,  2,  4,  92. 

Milk  constituents,  18. 

dirty,  24. 

goat's,  18. 

Pasteurizing,  30. 

sugar,  29. 

Motions,  28,  41,  72. 

Mumps,  95. 

NAPKINS,  51,  52,  55. 
Nervous  children,  82. 
Nose-bleeding,  98. 

foreign  body  in,  96. 

Nursery  milk,  25. 
Nursing,  83-91. 

OLIVE  oil,  46. 
Orange  juice,  37,  46. 

PAIN,  10,  78,  86. 

Paraffin,  15,  46,  48,  54. 
Patent  foods,  33-37. 

medicines,  76. 

Poisons,  99. 
Porridge,  39,  40. 
Poultices,  79,  88,  89. 
Punishments,  103,  104. 

RASHES,  9,  75,  76. 
Resting,  61. 
Rickets,  33,  35,  59,  60. 
Robb's  biscuits,  37. 
Rupture,  55. 


INDEX 


in 


SCARLET  fever,  94. 
School,  106. 
Scurf,  54. 
Scurvy,  36. 
Senna,  48. 
Shoes,  56. 
Skin,  care  of,  51. 
Soap,  52. 

Sodium  citrate,  28. 
Sore  throat,  10,  73,  95. 
Soxhlet  apparatus,  30. 
Spinal  curvature,  61. 
Starch,  43. 
Stockings,  56. 
Stomach  ache,  79. 
Sweat  rash,  76. 
Sweets,  12. 
Swimming,  60. 


TEA,  44. 
Teeth,  8-13. 
Thermometer,  73. 
Thread  worms,  72. 
Thrush,  53. 
Tonsils,  10,  66-70. 
Toys,  57. 
Tuberculosis,  9,  31,  32. 

VOMITING,  6,  49,  77. 

WATER,  44. 
Weight,  average,  8. 
Wet  feet,  65. 
Whey,  90. 

Whooping  cough,  9  . 
Worms,  72,  80. 


Printed  by  T.  and  A.  CONSTABLE,  Printers  to  His  Majesty 
at  the  Edinburgh  University  Press 


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